A 68-year-old woman with insulin-treated type 2 diabetes of 20 years' duration complained of pain on the back of the left heel and a superficial ulcer surrounded by a halo of erythema (Fig. 4.34a). She was unaware of the cause of the ulcer. An X-ray showed two dipped-off insulin needles in the soft tissues of her heel (Fig. 4.34b). She had previously
had an education session with the diabetes specialist nurse who emphasized the need for safe disposal of used needles and syringes. The patient had decided to clip off the ends of needles so that they could not be harmful and used a pair of wire cutters from her husband's tool box to do this. Her eyesight was poor and some of the clipped-off needles were dropped on to her bedroom carpet which had a long shag pile.
She was seen by the surgeons who advised not to remove the needles. She was prescribed antibiotics and the ulcer healed in 4 weeks. She underwent further education on safe disposal of needles and syringes, and avoiding barefoot walking, and disposed of her shag pile carpet.
' Feet with ulcers of unknown cause should be X-rayed
• High-risk patients should not walk barefoot, even in the bedroom
• Ascertaining causes of ulceration can prevent recurrences.
Thermal trauma including burns
Severe tissue damage and ulceration can be caused by thermal traumas.
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