A 63-year-old man with severe lesions in the right foot

Abstract

A 63-year-old man was hospitalized because of severe lesions in

his right foot (Figure 1A). These evolved with minor pain and had

first been observed approximately ten days before admission. The

changes were initially limited to the plantar surface of the second

toe, but the patient did not remember any recent trauma, because

of a chronic loss of local sensibility. Remarkable antecedents were

metabolic syndrome, arterial hypertension and type 2 diabetes,

which were controlled by another service by diet in addition to

metformin, gliclazide, and losartan. Two years previously, he had

undergone a surgical procedure involving the distal area of the

first right toe. His mother 83-years of age had had an amputation

of part of the left extremity caused by similar conditions.

Notwithstanding, he did not get enough knowledge about the selfmanagement

in this setting. He denied tobacco smoking, but

confirmed social alcohol consumption. His evaluation on

admission showed body mass index (BMI) 28.8 kg/m2, waist

circumference 110 cm, and arterial pulses in the lower limbs of

decreased amplitude. The rest of the physical examination was

unremarkable. Routine blood tests showed moderate anemia, mild

neutrophil leukocytosis, elevated erythrocyte sedimentation rate

(ESR) and C-reactive protein (CRP) level, hyperglycemia,

hypoalbuminemia, and high urea and creatinine levels. Cultures

from samples of the foot wounds revealed S. aureus sensitive to

clindamycin and ciprofloxacin, and these drugs were administered.

The imaging studies of the affected foot disclosed bone and

arterial changes (Figures 1B and 2). The patient underwent a

surgical procedure on the day 4 of admission, and the blood

control tests showed an improvement of hematological indices and

normalization of renal function. After hospital discharge, he is

under specialized surveillance at the orthopedic rehabilitation

service.

Keywords

• lesion,foot

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