Case 46: Resistant Leg Ulcer Heals with Outpatient Booting

Ulcer on Back of Right Leg on Presentation (Center), Foot in Black Stocking (Left) and Pants (Right)

This elderly diabetic retired soldier had a painful ulcer on the back of his right lower calf which had resisted the care of his family doctor and his diabetologist. Doppler studies showed his posterior tibial and peroneal arteries to be severely compromised while his anterior tibial provided borderline but satisfactory flow to his foot. He responded nicely to his boot therapy and healed his ulcer. The presenting lesion remained healed until his death 16 months later. During this interval, however, he returned for a few treatments of his other leg which developed a small ulcer and also healed.

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Thin Scab Marking Site of Previous Ulcer

Comments: Here a elderly debilitated soldier received a few outpatient boot treatments and maintained his legs and life style until his death. Economical, effective and nonstressful for the patient and the family. Some HMO's would have denied him the outpatient care but approved an inpatient attempt at bypass. Vascular surgeons are more persuasive than medical men.