Case65: Foot, Progressively Worsened after Debridements, Saved by Boot

This 84 year old man had insulin-dependent diabetes and peripheral neuropathy. He developed a infected plantar ulcer in early June 1987 that took him to his surgeon. He was hospitalized and given intravenous antibiotics. Multiple debridement procedures were performed but merely seemed to extend the lesion. His wife came by a sensational summary in the National Enquirer of an article on the Circulator Boot that had been published in the Annals of Surgery. He prevailed upon his surgeon to arrange for his transfer across the state to Bryn Mawr for boot treatment. He arrived September 5th, 1987.

He presented with a large necrotic ulcer under his heel with obvious extensions of the necrotizing process into his arch and up the lateral aspect of his ankle to his external malleolus

At the time of discharge, his arch and ankle were healthy and the ulcer was clean and closing nicely.

He was treated several days in the hospital with our usual techniques: initial cleansing foot soak, local antibiotic injections and Mini-boot treatments with his foot immersed in Sea Soaks and appropriate antibiotics. The same treatments were continued after discharge at our nearby nursing facility. He continued to read about innovative foot treatments and discovered an article from his hometown newspaper that a local doctor was doing hyperbaric oxygen treatments for diabetic legs. He went home with a bottle of Sea Soaks and tried a few hyperbaric treatments. He continued his soaks and healed. His leg did well until his death in December of 1992.

Comments: Debridements require great judgment. The patient must heal both the pathological process and the wound inflicted by the surgeon. Here the surgeon was frustrated to find his work continually infected and the lesion progressively larger. Our local use of antibiotics insured an effective concentration of antibiotics reached the necrotic tissue. Our pumping within the Sea Soaks provided a gentle benign means of debriding the ulcer without extending it. The pumping further helped improve his local circulation. Result: success where there was none. This patient also illustrates a problem with patient compliance. Patients coming of their own accord without the encouragement of their own physicians continue to look for new therapies and are willing to "switch horses in mid-stream".