Case 76:Toe Does Well and Remains Intact up to Follow-up 7 Years Later, an Easy Case

At age 40, this female smoker and insulin-dependent diabetic noted swelling of her foot on December 21, 1987. She went to her podiatrist who drained the toe and prescribed oral antibiotics. She visited her family doctor December 23rd and was admitted to the Bryn Mawr Hospital. An orthopedic surgeon was consulted and intravenous antibiotics therapy initiated. Vascular testing revealed an ankle/arm index of 0.47. Black areas began to develop on the toe leading the orthopod on December 29th to call for a "boot" consultation and evaluation of the toe ulcer and expected associated osteomyelitis.

Small areas of focal necrosis were apparent on the medial-dorsal aspect of the toe.

Probing with a culturette stick showed the previous abscess cavity penetrated to the bone.

The toe did well with our usual routine: an initial cleansing foot soak, an injection of appropriate antibiotic into the toe, placement of the foot in a bag containing Sea Soaks and appropriate antibiotic and Mini-Booting of the foot immersed in the Sea Soaks-antibiotic solution. She was treated a few days in the hospital and followed up in the office with similar treatments until she was healed. Follow-up phone calls up to July 1994 revealed her foot remained intact.

Two Weeks Later

Comments: The problem of this lady was solved in a month. If she was seen earlier, her hospitalization likely would have been avoided and the cure quicker. She appears to be an easy case. Elsewhere, vascular surgery might have been consulted and a bypass accomplished. Again, elsewhere, the toe might have been amputated and, in view of her diminished circulation, might not have healed. Again... In any event, such cases can be awfully easy with our boot techniques..