Case 166: Indolent Ulcer of Physician over Achilles Tendon Heals with Outpatient Boot Treatments

This 66 year old physician presented November 3rd, 1992 with a painful indolent ulcer over his right Achilles tendon, which he had ruptured on August 15th. He was a former smoker and a non-diabetic. His orthopedic surgeon had sutured his tendon together and placed his leg in a cast. When the cast was removed, he was found to have an ulcer over his Achilles tendon. The care of the ulcer was assigned to a plastic surgeon who among other things prescribed dilute Betadine cleansing soaks. As the ulcer did not improve, the patient came for a boot consultation. He had some varices and some ?stasis/?post inflammatory pigmentation over his Achilles tendon. His distal leg was modestly ruborous. His ankle/arm index was normal at 1.14. He was treated initially daily with local antibiotic injections and the Long-Boot and then, as his pain receded and healing had obviously begun, he was treated intermittently for eleven months. His satisfaction with his healing rate and his work schedule set the frequency of his treatments

February 8th, 1993: foot and leg color improved. Pain largely gone.

March 2nd, 1993: new granulations, ulcer smaller and further improvement in overall foot color and turgor.

April 22, 1993: Further improvement. The insulin syringe was used to infiltrate antibiotics into and around the ulcer area prior to his Long-Boot treatments and the gauze was wetted with Sea Soaks containing appropriate antibiotics and applied as a wet-to-dry dressing during his treatments.

August 30th, 1993: Happy and close to healed. His leg did heal and as of March 11th, 1998 has continued to serve him well.

Comments: A difficult lesion in a doctor not responding to the treatments of other doctors. Betadine soaks do not promote healing. We like our Sea Soaks. His lesion is hard to classify. Poor healing due to what? His smoking may have promoted arteriosclerosis and his ABI may be deceptively high due to medial calcinosis. He had a lot of stasis pigment, but his lesion is not in a usual stasis ulcer location. For this list, we will enter him under stasis disease.