Case 9: Pulseless Distal Feet Salvaged in Patient with Buerger's Disease

Mottled Painful Feet on Presentation

This 50 year old alcoholic male smoker was referred by his vascular surgeon from a nearby hospital when standard therapies there appeared not to benefit him or relieve his pain. His 2-pack/day smoking habit, his case of beer/day habit and a stuporous sleep over a few days associated with dehydration, polycythemia and venous stasis all likely contributed to the blueness and swelling of his feet that gained him admission to his local hospital. A venogram revealed multiple thrombi in his calves. Nonspecific RST changes on his cardiogram and multiple premature beats were thought to be compatible with an alcoholic myocardiopathy. He was treated with heparin, bedrest and subsequently coumadin with a decrease in the swelling of his feet over several days but pain and the changes shown in our baseline photograph persisted. At the time of his transfer to the Bryn Mawr Hospital, his mobility was limited to bedrest and a wheelchair.

Skin Growing under Necrotic Toe Tips

Baseline Doppler studies of his arteries were essentially normal to the midfeet; distally the feet were pulseless. He was treated first with foot soaks containing microfiltered sea water and Betadine. The feet were then pumped in the Miniboot with his feet immersed in isotonic diluted sea water (Sea Soaks TM) containing gentamicin. The soles of his feet improved within the first few days. The necrotic areas of his toes firmed up and then separated as skin grew beneath them. Strong Doppler waveforms were eventually documented in all of his toes. He did well.

Healed, Ambulatory and Pain-free

Comments:The usual therapies for thromboembolism had failed to clear the thrombi from the feet of this man. His toes appeared to be mummifying and his pain had been unrelieved. Such feet are extremely painful, especially in nondiabetics with normal sensation. They may find therapy with their legs extended horizontally in our Long Boots to be painful. They are usually quite comfortable during Miniboot therapy which is accomplished in the sitting position. If they do have pain, it is usually lessened by pumping them with their feet immersed in our Sea Soaks solution. How else might this man's feet have been salvaged? His referring physicians had given his feet up for lost. Another small kick to the moon?