Soft Tissue Infection

A 58-year-old male patient with type 2 diabetes, diagnosed at the age of 45 years, attended the outpatient diabetic foot clinic for chiropody treatment on a fortnightly basis. He had severe peripheral neuropathy, claw toe deformity and prominent metatarsal heads. He mentioned mild pain on his left midsole on finding a coin in his shoe after prolonged walking.

On examination, he had a lax blister containing purulent fluid under his left midsole. There was extensive surrounding erythema and callus formation under the second metatarsal head (Figure 8.3). The blister was removed and dressed, and the patient was advised to use crutches and walk on his heel. He was treated with clindamycin for 2 weeks. Debridement of the callus was also carried out.

The blister had developed following an unrecognized trauma to the foot. Such injuries are detrimental to patients with loss of sensation. The coin in the patient's shoe put an additional load under his midsole. All patients with loss of protective sensation should be instructed to inspect and feel the inside of their shoes before they wear them. A selection of objects collected from

Treatment Blisters Under Callus
Figure 8.3 A lax blister containing purulent fluid under the midsole with extensive surrounding erythema. Injury caused by a coin in the shoe which was not felt by the patient. Callus formation under the second metatarsal head is apparent

patients' shoes at the outpatient diabetic foot clinic is shown in Figure 8.4.

Diabetic bullae may also cause blisters in diabetic patients. They occur on the lower legs, the dorsum of the feet, hands, and forearms and less commonly, under the soles of the feet. Diabetic bullae more often affect men. They appear suddenly as tense and usually bilateral blisters, with diameters of 0.5 to several cm; they contain clear fluid without any surrounding erythema and heal in a few weeks without scarring. Relapses are common.

Keywords: Trauma; in-shoe foreign objects; diabetic bullae

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Responses

  • markus
    Is watery blisters formed in soft tissue?
    3 years ago

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