Case 34: Foot, Heart and Hand... and Long Life

Born July 12th, 1901 and diabetic since 1946, this gentleman had a left BK amputation for ischemic ulcers in 1974. His wife, aware of the dismal survival statistics for the other leg and his life (see our literature/epidemiology section) lamented his life was over. However, he took a new interest in controlling his diabetes learning first to check his urines four times daily and later switching easily to checking his blood glucose levels four times daily. He became a "good" diabetic.

Problems with the other leg began in 1976; he developed a paronychia of the big toe that responded to conservative measures. He started therapy with Circulator Boot prototypes beginning 4/5/78, first for a big toe ulcer and then for a plantar ulcer. Both lesions healed and he did well for a year when he developed yet another ulcer on his big toe. He was booted from September 1979 to January 1980 and healed again. He was now an experienced boot believer. On December 4th, 1985 he developed a small abrasion of his 5th knuckle from which he noted a little pus that grew out Staphylococcus epidermis and Staphylococcus aureus, both sensitive to first generation cephalosporins. Cephalexin (Keflex) and hot hand soaks were prescribed without effect. He returned 12/9/85 with his hand swollen and obviously in trouble.

12/9/85 Swollen Hand and Wrist

Pus Easily Aspirated from His Hand

X-rays of his hand showed generalized osteoporosis, severe degenerative changes involving the 1st carpometacarpal joint and the distal interphalangeal joints, cystic changes in the carpal bones, deformities of the distal radius and ulna from old trauma, marked arteriosclerosis and chrondrocalcinosis. His wedding ring was stuck on his 4th finger. The latter was removed intact by winding a rubber band around his finger from his fingernail to the edge of the ring, thus forcing the fluid from the finger. The ring was easily passed over the rubber band which was soaped. He was advised to enter the hospital for parenteral antibiotics and possible surgical drainage. A "real booter", he asked why we could not treat his hand like we had treated his foot. So we did. Gentamicin was injected into his hand which was then pumped in the Mini-Boot. He was so treated six times as an outpatient. His hands did well.

12/16/85 Reduced Swelling and Normal Color

1/15/86 Good as New

His foot had not troubled him for six years. Then, at age 85 he presented September 1986 with cellulitis and an ulcer under his 5th metatarsal head. The latter were treated with local gentamicin injections and Mini-Boot therapy. Osteomyelitis of the fifth metatarsal head healed but a necrotic ulcer developed over the proximal 5th metatarsal where again underlying osteomyelitis was suspected. On November 1, 1986 he developed fever and dypsnea. His foot was ulcerated (picture) but his symptoms were attributed to congestive heart failure and pneumonitis. He was hospitalized a few days and treated with systemic antibiotics, local antibiotics and both Mini- and Long-Boots.

Resolving Osteomyelitis of 5th Metatarsal Head and Probable Osteomyelitis of Proximal 5th Metatarsal

His dypsnea improved and fever abated and he continued his outpatient treatments healing his foot. He soon returned with a new larger problem. In March, 1987, he fractured his ankle, developed a lateral malleolar ulceration and a pyoarthritis of the ankle with Pseudomonas aeruginosa.

Ankle Fractured, Unstable and Infected

Local Injection of Gentamicin

Pyoarthritis was treated with injections of gentamicin into the ankle joint followed by boot therapy all as an outpatient. His ankle was supported by a fiberglass cast. And a steel ankle brace attached to his shoe was prescribed. He remained ambulatory , cared for his ailing wife and rode his tractor around his lawn. When his wife died, he moved to Connecticut to be nearer to his daughters... and died there in May, 1995.

Healed and Ready to Go

Comments: This patient survived seven leg lesions and a hand infection. He lived close to 94 years old outliving his wife and friends... in spite of 22 years as an amputee and 49 years as a diabetic. His boot therapy was adapted to his needs: support the heart with congestive failure, treat his hand or treat his foot.