Mr. Lopez is a 55-year-old male who has history of Type II Diabetes for 10 years. He is taking oral medications for diabetes, high blood pressure and high cholesterol. He came to the emergency room because the bottom of his foot was swollen and red but he didn’t have any pain. His wife said she noticed yellow and greenish fluid with a foul smell coming from between the toes (Fig 1).
Physical examination of the right foot in the emergency room showed he had swelling and accumulation of pus at the bottom of the foot. While in the emergency room, the bottom of the foot was incised with a scalpel to drain all the pus (Fig 2). The infection and the pus were found to be coming from between the little toe and the next toe. That area had a fungal infection also known as athlete’s foot and callus.
The area between the toes got infected and the bacterial infection entered into the bottom of the foot causing the pus at bottom of the foot. The patient was admitted in the hospital for treatment of his foot infections. The patient was found to have a severe circulation problem, so he was seen by a vascular surgeon.
The vascular surgeon determined that the infection is difficult to heal because he has severe circulation problems. He received a revascularization procedure to improve circulation to the right foot. After revascularization of the right foot, the wound was able to heal (Fig 3) but took several months to complete the healing.
As noted, this wound would not be able to heal without improving circulation, and he would have had a leg amputation.
