Case 171: Diabetic Foot: Treated Foot Does Well While Other Foot Becomes Infected in Feisty Independent Lady

This feisty 73 year old lady had type 2 diabetes and a plantar ulcer that had defied treatment for 18 months. She discovered our foot program through a article in the National Enquirer. Her pedal pulses were absent and her ankle/arm index was reduced to 0.89. Her diminished sensation and obvious hammertoe deformities suggested neuropathy was the major factor promoting her ulcer disease.

February 19, 1988: Baseline of left foot.

She responded nicely to the boot program (appropriate antibiotics injected locally and used in the Mini-Boot bath) and disappeared before her discharge picture was taken. She returned, however, a year later with an infection in her other foot.

March 23, 1989: A cellulitis of the right foot had developed.

Her left foot remained intact.

We loaded up her right foot with gentamicin, gave her a sample of Augmentin to prevent septic emboli and began Mini-Boot therapy. Unfortunately, she developed a rash on the Augmentin. She was lost to follow-up as she sought the care of another physician who might know how to prescribe antibiotics properly without causing such a rash.

Comments: This lady is added to illustrate the difficulties encountered in collecting clinical series. She left her previous physician because of a newspaper article, not a likely opportunity today for our HMO patients. She left us because she perceived us to be incompetent in giving her an antibiotic to which she proved to be allergic. Our older patients commonly prove to be difficult management problems, less because of their foot problems than because of problems with insurance, HMO medical directors, transportation, forgetfulness, multiple drug allergies and other medical problems.