Case 60: Distal Ischemia Responds Nicely to Boot after Previous Inadequate Response to Bypass

This 65 year old former smoker underwent bypass surgery December 1st, 1994 but foot ischemia persisted leading to her referral for boot therapy. Her arm/ankle indices were 0.59 and 0.84 in the right and left foot respectively. Photoelectricplethysmographic (PPG) tracings of her toes were flat.

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Both feet were ruborous and the ends of the right 4th and 5th toes were necrotic.

The dorsum of the feet, the right more than the left, were ruborous also.

Both feet were treated with the Mini-Boot and did well. Her toes healed and she returned to work.

The color and texture of the skin and nails improved markedly.

New skin grew under the necrotic areas which pealed off.

Comments: This lady did benefit from her bypass but not enough to heal her foot and relieve her pain. The Mini-Boot was able to complete the cure. All too often doctors take adversative positions defending their treatment modalities against that of others. Here the patient benefited from the cooperation of surgical and medical disciplines..