Case 61: Progressive Foot Infection Checked and Healed

This 79 year diabetic male had had some podiatry work done two weeks prior to admission to the hospital. He had a long history of poorly controlled diabetes. He was started on intravenous tobramycin and nafcillin by his family physician on admission. A foot x-ray showed no signs of osteomyelitis. Noninvasive vascular testing by the hospital laboratory showed ankle/arm blood pressure indices of 1.3 in the right leg and 1.25 in the left. The infection progressed leading to a vascular surgery consultation and a debridement and drainage procedure under the fifth metatarsal head. Because of continued progression of the infection a boot consultation was requested.

On presentation for boot therapy, the 2nd toe was found to be puffy and hyperpigmented.

From this aspect, the 2nd toe appeared slightly bluish and pus was draining from the webspace between the 1st and 2nd toes.

His infection had dissected along the plantar surface of the foot from the fifth toe to the second toe. The obviously infected portions of his foot were infiltrated with gentamicin and ampicillin with an insulin syringe. His foot was then pumped in the Mini-Boot with the foot immersed in multi-electrolyte solution (Sea Soaks) to which the same antibiotics had been added His hospital course was complicated and prolonged by a bladder tumor and urological procedures. He was discharged after a seven week hospitalization to be further booted in the office. Then his antibiotics in the boot were changed to gentamicin and vancomycin. His foot healed nicely and caused him no further difficulty over his three year follow-up period.

His second toe returned to normal color.

The sole of his foot was scarred but intact and solid.

Comments: Another example of the power of the use of locally injected antibiotics and the Boot. Infection has been a contraindication for the use of lymphedema boots in the eyes of Medicare. Some insurance carriers, in their desire to minimize their expenses, have also claimed that infection is a contraindication for use of the Circulator Boot systems. This stance is awfully short-sighted. Used early in the course of infection, we have virtually sterilized some feet in one day. Unfortunately, most patients are referred only after their infection has proved resistant to oral and intravenous antibiotics and has produced considerable tissue damage.