Case 39: Salvaging Last Leg by Healing Lesions at Heel, Achilles Tendon and Big Toe

This 64 year old black female smoker was admitted with congestive heart failure and an ischemic right leg in July 1985; her right leg was amputated. Diabetes was subsequently discovered. Her left leg developed ulcers on her heel and over her Achilles tendon leading again to hospitalization. The ulcers did not improve and the possibility of another leg amputation was entertained. She had no popliteal or tibial pulses. Her Doppler arterial wave-forms were low and broad. Her ankle blood pressure readings were 40 mm Hg in the posterior tibial and 100 mm Hg in the anterior tibial. A level of 30 mm Hg was found in the midfoot while her brachial pressure was 160 mm Hg. Her family requested that everything be done for her to avoid an other leg amputation and she was referred for boot therapy.

Focal Necrosis at Paronychia Site at Time of Boot Referral on 11/13/85

Heel and Achilles Ulcers at Same Time

Her boot program included (a) an initial cleansing foot soak in purified seawater and Betadine; (b) the addition of isotonic Sea Soaks containing antibiotics to a plastic bag in which her foot was placed within the Mini-Boot; (c) Mini-Boot therapy with a boot bag enclosing both her leg from the knee to the toes and the inner plastic bag which contained both her foot and the antibiotic solution; and (d) Long-Boot treatments with a sleeve extending from her groin to the proximal Achilles tendon. Her leg did well. Her foot required periodic debridement of callus at both sites. Her family wanted to know why she was not offered boot therapy before the amputation of her right leg.

12/1/85 Healed Lesions and a Happy Lady

Comments: This lady's leg served her well until her death seven years later. Her medical and nursing costs were reduced and her quality of life significantly increased with the use of her last leg.