When my mom saw that her hammer toe was bright red and swollen, she knew she was in trouble, even though she was in no pain. Mom, a type 2, had been to her podiatrist just two weeks before for routine foot care. This included trimming a callus on that toe. My mom takes great care of her diabetes. She tests before each meal, has good HbA1cs and sees her doctors regularly.
She went back to the podiatrist, who lanced it and started her on oral antibiotics. He had her dress it with iodine gel and told her to change the bandage every day, taping the bandage to her skin.
Two weeks later, mom noticed redness (cellulitus) in her leg almost up to her knee. Now she had to go to the emergency room.
The ER doctor gave her intravenous (IV) antibiotics and had her come back every day for several days to get more IVs. Each time she went in, they refused to even look at her toe. Instead, they said, "We don't do toes. Wait until your next appointment with the podiatrist."
I was able to go with my mom to her fourth day of IV antibiotic treatment, and we decided to track down a podiatrist to look at her toe. The podiatrist she started with was on vacation so a new guy saw her. He had me hold up her leg while he cut away the dead skin. This caused it to bleed profusely, so they had to apply a special "cottony" substance to stop the bleeding.
The new podiatrist said to put Neosporin in the wound and to soak it daily in a betadine and water solution. The redness in her leg went away, but the ulcer in her toe remains.
Three days later, her original podiatrist did more debreeding and told her to go back to using the iodine (iodosorb gel) he had originally prescribed. Also, contrary to what the previous doctor advised, he said he did not recommend soaking it and told her to stop. Then the doctor scheduled my mom for a hammer-toe-release surgery on that same toe.
The day before the surgery, my mom found a two-page summary on foot care that I had given her several years ago written by Dr. Richard Bernstein (see side bar). Besides having been on DIABETES HEALTH's advisory board for 10 years, Dr. Bernstein is a certified wound specialist. In reading Dr. Bernstein's summary on foot care, we realized my mom's doctors had done almost everything differently from what Dr. Bernstein recommends. For instance, he says to:
- never let anyone trim your calluses
- never soak your feet-it breaks down the skin
- not put tape on the skin
- never debreed down to live tissue
Because it seemed her health care providers were obviously not up to speed on diabetic foot care, I had to get advice from another source on whether mom should have the hammer-toe-release surgery or not. I called Dr. Bernstein. He said not to have the surgery. He said a special shoe would be a better way to handle the hammer toe.
Dr. Bernstein also told me never to use iodine because it kills fibroblasts, which the body needs to make new skin.
Mom is not yet out of the woods. If an infection reaches the bone, this can lead to gangrene. Then the toe, and maybe even more, would have to be removed. Once a toe has been taken off, more pressure is placed on the other toes and the other foot. This can lead to other sores and amputations. Statistics show that after this process gets going and someone loses their mobility, they don't live very long.
I now feel pressure to make up for what my mom's HMO lacks, but I don't yet know exactly how to do it. It was my mom who cared for me when I was first diagnosed and brought new information into our home on how to best handle this disease. Now the tables are turned.
My mom is a gutsy, 79-year-old woman who is not ready to take this sitting down.
Email her at email@example.com if you have suggestions.
26 Years with Diabetes
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