A 25-year-old man with type 1 diabetes of 15 years' duration presented with a painful nail sulcus and underwent removal of a spike of nail. The toe was dressed with
Melolin and Tubegauz and he was advised to attend his practice nurse for dressings and return to the diabetic foot service in 2 weeks. At his next appointment we found a ring of superficial necrosis around the base of the toe (Fig. 4.12). On interrogation as to the cause of this, he blushingly admitted that he had not attended the nurse, but had applied dressings from his home first aid kit held in place by a rubber band around the toe.
• Patients should be given advice regarding application and fixing of dressings
• Tight bandages and ligatures encircling a digit should be avoided.
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