Normally I apologize before posting a Blog on a previously covered subject. In this case once more is never enough.
The patient was in his late 60s, a poorly controlled type 2 diabetic with pronounced peripheral vascular disease (reduced blood to the feet) and neuropathy (partial loss of feeling in feet). He attends our clinic every 8 weeks for routine care (nail trimming and callous reduction).
During these visits, we also perform a checkup on his feet to identify potential risks unique to his diabetic status and catch up on politics. Depending on the fragility of the patients diabetic status we periodically perform a more in-depth evaluation of their vascular and neurological status to identify any deterioration in the condition.
On this occasion while preparing to perform his periodic routine care I noticed on the ball of his foot a minute wound with some redness around the area. He reported no awareness of the lesion nor any tenderness. He did admit that he habitually goes barefoot around home despite our repeated warnings to the contrary.
Upon gentle probing with fingers and then a scalpel it was clear that something hard was lodged in the tissue. With a little gentle encouragement and an enlargement of the entry wound a large fragment of glass was extracted from the wound.
Even the most diligent efforts to clear broken glass, with the benefits of good flexibility and clear eyesight can result in some frighteningly large shards remaining undetected.
For an individual with normal sensation a fragment this size would have been excruciating and immediately identifiable. For our patient, undetected the wound would have remained open allowing bacteria to enter and causing a systemic infection and further loss of blood sugar control. Such wounds on the bottom of the foot are especially difficult to heal and can present a realistic risk to both limb and life.
As tedious as it may be, we explain to our more “at-risk patients” each and every day and give the same advice regarding footwear, stability and protection.
As in many walks of life, the least glamorous parts of our jobs can have the most beneficial impact on others.
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