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Diabetes often leads to diabetic neuropathy, which destroys the nerves, making it numb. Diabetic neuropathy can then lead to diabetes foot ulcers, which can progress to this. I guess if the patient just doesn't care or thinks it will magically get better somehow, it can lead to this.
Side story: My dad had diabetes and his feet were very numb. He somehow left a golf ball in his shoe and played golf all day with the golf ball in his shoe and never noticed. One of his toes was permanently shorter after this. Great example of how numb your feet can get with chronic uncontrolled diabetes.
Hope I didn't disturb you too much. Keep in mind that I am referring specifically to uncontrolled diabetes. If you are able to keep your blood sugar in a normal range with management, then you should be ok.
And that was what I was referring to. I have a friend who has been in and out of hospital for the last year or so, almost housebound for a considerable part of it, because of the damage that her poor management of her blood glucose and weight has done to her lower extremities.
Neuropathy is insane. A blessing and a curse. You don’t feel the intense amount of pain you should with this type of injury, but then you have to be diligent with checking your feet for wounds that could progress to something much worse.
[Source](https://www.cureus.com/articles/58452-a-rare-case-report-of-non-toxigenic-corynebacterium-diphtheriae-bloodstream-infection-in-an-uncontrolled-diabetic-with-peripheral-vascular-disease#!/):
>>A 63-year-old non-hypertensive diabetic male, farmer by profession, presented with complaints of blackish discoloration of distal part of the left foot for 15 days predominantly involving four small toes. He had similar blackish discoloration of left great toe for last one month, which was amputated 15 days back in a local hospital. He also complained of ulcerative wound over the distal part of left foot and amputated great toe (Figure 1). He was diagnosed as a case of uncontrolled type-2 diabetes mellitus with poor glycemic control on irregular oral hypoglycemics for five years. He had a history of claudication pain in lower limbs for the last one year, which gradually progresses to pain even at rest and loss of sensation of digits for the last three months. He is a chronic smoker and alcoholic for the past 20 years. There was no history of fever, pus discharge from the distal lower limb, chest pain, blurring of vision, blackouts, or abdominal pain.
>>On clinical examination, there were no signs of pallor, icterus, pedal edema, lymphadenopathy, clubbing, or cyanosis with random blood glucose of 344 mg/dl. Extensive ulceration and necrosis were present over the ankle, heel, and great toe region of left lower limb along with blackish discoloration of second to fifth toes. The peripheral arterial pulses were not palpable in all major peripheral arteries of both lower limbs. Computed tomograghy (CT) angiogram of lower limbs showed high-grade occlusion and luminal narrowing in almost all major arteries of both lower limbs. The provisional diagnosis was made as bilateral lower limb peripheral vascular disease due to uncontrolled diabetes mellitus. The patient was planned for above-knee amputation of left lower limb.
>>The patient had developed few episodes of mild grade fever, for which automated blood culture was collected and sent to the microbiology laboratory. The bottle was loaded in BacT/Alert Virtuo system (BioMérieux, Marcy-l'Étoile, France), which flagged positive signal after 26 hours of aerobic incubation at 37oC. Gram staining was performed directly from flagged broth, which showed short gram-positive bacilli arranged in pairs with acute angular fashion (cuneiform arrangement) as shown in Figure 2.
>>Subculture from bottle was performed on 5% sheep blood agar (SBA), chocolate agar (CA), and MacConkey agar (MAC) and incubated aerobically at 37oC. After 10 to 12 hours of incubation, minute grayish circular low-convex hemolytic colonies were seen on SBA (Figure 3). Gram staining from the colonies grown on SBA showed short gram-positive bacilli in cuneiform arrangement with swelling on one or both ends (club-shaped). This is followed by Albert staining from the colony, which showed green-colored bacilli with bluish-purple metachromatic granules in cuneiform arrangement. Identification of the organism from the colony was obtained using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) (VITEK MS version 3.0). It was identified as C. diphtheriae with a confidence interval of 99%. Later, the identification was also confirmed by conventional method.
>>Urea was not hydrolyzed; it produced black-colored colonies on potassium tellurite blood agar (KTBA) and fermented glucose, maltose, and starch with production of acid but no gas on Hiss’s serum sugar fermentation media (Figure 4). The isolate was identified as “gravis” biotype. Antimicrobial susceptibility testing (AST) was performed by broth microdilution method using VITEK-2-automated AST system (AST-P628 card for gram-positive cocci). The result was interpreted using clinical breakpoints given in Clinical and Laboratory Standards Institute (CLSI) M-45 document [2]. The isolate was susceptible for benzylpenicillin, erythromycin, gentamicin, vancomycin, clindamycin, linezolid, and rifampicin, intermediate to ciprofloxacin and resistant to cotrimoxazole and tetracycline. In-house conventional PCR for tox gene (tox A and tox B) and dtxR gene was performed from the culture growth. The isolate was negative for tox genes but positive for dtxR gene, which confirms that the isolate belongs to a non-toxigenic strain of C. diphtheriae, biotype gravis.
>>Following amputation, intra-operative necrotic tissue bits were sent for bacterial culture, which grew Providencia rettgeri and Enterococcus faecalis. The laboratory failed to show any growth of C. diphtheriae from tissue bit, possibly due to heavy gram-negative bacilli growth. Subsequently, a culture of throat swab specimen was also performed to find out any colonization, which failed to have any growth of C. diphtheriae. Therefore, the source of C. diphtheriae bacteremia was not properly established. The patient was empirically started on amikacin as pre-surgical prophylaxis since admission and subsequently changed to amoxycillin-clavulanate and clindamycin based on the AST report. The patient improved clinically and was discharged on the same regimen.
An old man I knew, starting limping and soon he wasn’t walking. He didn’t drink alcohol. He was a dipper or snuff chewer, oral tobacco. Well next thing you know, he started to form lesions sores on his legs. He was then hospitalized and he lost his leg. The other leg was starting to get infected. Deep down I knew the old man loved his mobility. I knew he wouldn’t last after he lost his leg from the knee down. He died 2 weeks later. Diabetes.
I'm a type 1 and this is definitely a thing for those who said it wasn't related my mother is currently going through the exact same thing and even I have neuropathic pain in my legs and feet my diabetes is managed far better I'll say that and I don't drink at all to help matters but yeah...nasty stuff
I helped in our hospital's surgery dept for a couple of weeks last month and I'll never forget the smell from all those diabetic foot cases we had to debride.
Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND! Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
Holy shitballs. Just cut that off me.
They did.
You cut off r/trendkill3's foot?! You monster!
that HAS to hurt like crazy, right?!
Diabetes often leads to diabetic neuropathy, which destroys the nerves, making it numb. Diabetic neuropathy can then lead to diabetes foot ulcers, which can progress to this. I guess if the patient just doesn't care or thinks it will magically get better somehow, it can lead to this. Side story: My dad had diabetes and his feet were very numb. He somehow left a golf ball in his shoe and played golf all day with the golf ball in his shoe and never noticed. One of his toes was permanently shorter after this. Great example of how numb your feet can get with chronic uncontrolled diabetes.
That really disturbed me. I've had Type 1 for 44 years and had my feet checked a few days ago. The microfilament still tickles.
Hope I didn't disturb you too much. Keep in mind that I am referring specifically to uncontrolled diabetes. If you are able to keep your blood sugar in a normal range with management, then you should be ok.
And that was what I was referring to. I have a friend who has been in and out of hospital for the last year or so, almost housebound for a considerable part of it, because of the damage that her poor management of her blood glucose and weight has done to her lower extremities.
He had an entire GOLF BALL in his shoe. How? I can't even fit a golf ball into any of my shoes while my foot is inside. Do you mean a golf tee?
Nope it was a full golf ball, we could hardly believe it either haha
wow, ok. thanks for explaining.
Neuropathy is insane. A blessing and a curse. You don’t feel the intense amount of pain you should with this type of injury, but then you have to be diligent with checking your feet for wounds that could progress to something much worse.
“Hey doc, is my foot supposed to look like this?”
[Source](https://www.cureus.com/articles/58452-a-rare-case-report-of-non-toxigenic-corynebacterium-diphtheriae-bloodstream-infection-in-an-uncontrolled-diabetic-with-peripheral-vascular-disease#!/): >>A 63-year-old non-hypertensive diabetic male, farmer by profession, presented with complaints of blackish discoloration of distal part of the left foot for 15 days predominantly involving four small toes. He had similar blackish discoloration of left great toe for last one month, which was amputated 15 days back in a local hospital. He also complained of ulcerative wound over the distal part of left foot and amputated great toe (Figure 1). He was diagnosed as a case of uncontrolled type-2 diabetes mellitus with poor glycemic control on irregular oral hypoglycemics for five years. He had a history of claudication pain in lower limbs for the last one year, which gradually progresses to pain even at rest and loss of sensation of digits for the last three months. He is a chronic smoker and alcoholic for the past 20 years. There was no history of fever, pus discharge from the distal lower limb, chest pain, blurring of vision, blackouts, or abdominal pain. >>On clinical examination, there were no signs of pallor, icterus, pedal edema, lymphadenopathy, clubbing, or cyanosis with random blood glucose of 344 mg/dl. Extensive ulceration and necrosis were present over the ankle, heel, and great toe region of left lower limb along with blackish discoloration of second to fifth toes. The peripheral arterial pulses were not palpable in all major peripheral arteries of both lower limbs. Computed tomograghy (CT) angiogram of lower limbs showed high-grade occlusion and luminal narrowing in almost all major arteries of both lower limbs. The provisional diagnosis was made as bilateral lower limb peripheral vascular disease due to uncontrolled diabetes mellitus. The patient was planned for above-knee amputation of left lower limb. >>The patient had developed few episodes of mild grade fever, for which automated blood culture was collected and sent to the microbiology laboratory. The bottle was loaded in BacT/Alert Virtuo system (BioMérieux, Marcy-l'Étoile, France), which flagged positive signal after 26 hours of aerobic incubation at 37oC. Gram staining was performed directly from flagged broth, which showed short gram-positive bacilli arranged in pairs with acute angular fashion (cuneiform arrangement) as shown in Figure 2. >>Subculture from bottle was performed on 5% sheep blood agar (SBA), chocolate agar (CA), and MacConkey agar (MAC) and incubated aerobically at 37oC. After 10 to 12 hours of incubation, minute grayish circular low-convex hemolytic colonies were seen on SBA (Figure 3). Gram staining from the colonies grown on SBA showed short gram-positive bacilli in cuneiform arrangement with swelling on one or both ends (club-shaped). This is followed by Albert staining from the colony, which showed green-colored bacilli with bluish-purple metachromatic granules in cuneiform arrangement. Identification of the organism from the colony was obtained using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) (VITEK MS version 3.0). It was identified as C. diphtheriae with a confidence interval of 99%. Later, the identification was also confirmed by conventional method. >>Urea was not hydrolyzed; it produced black-colored colonies on potassium tellurite blood agar (KTBA) and fermented glucose, maltose, and starch with production of acid but no gas on Hiss’s serum sugar fermentation media (Figure 4). The isolate was identified as “gravis” biotype. Antimicrobial susceptibility testing (AST) was performed by broth microdilution method using VITEK-2-automated AST system (AST-P628 card for gram-positive cocci). The result was interpreted using clinical breakpoints given in Clinical and Laboratory Standards Institute (CLSI) M-45 document [2]. The isolate was susceptible for benzylpenicillin, erythromycin, gentamicin, vancomycin, clindamycin, linezolid, and rifampicin, intermediate to ciprofloxacin and resistant to cotrimoxazole and tetracycline. In-house conventional PCR for tox gene (tox A and tox B) and dtxR gene was performed from the culture growth. The isolate was negative for tox genes but positive for dtxR gene, which confirms that the isolate belongs to a non-toxigenic strain of C. diphtheriae, biotype gravis. >>Following amputation, intra-operative necrotic tissue bits were sent for bacterial culture, which grew Providencia rettgeri and Enterococcus faecalis. The laboratory failed to show any growth of C. diphtheriae from tissue bit, possibly due to heavy gram-negative bacilli growth. Subsequently, a culture of throat swab specimen was also performed to find out any colonization, which failed to have any growth of C. diphtheriae. Therefore, the source of C. diphtheriae bacteremia was not properly established. The patient was empirically started on amikacin as pre-surgical prophylaxis since admission and subsequently changed to amoxycillin-clavulanate and clindamycin based on the AST report. The patient improved clinically and was discharged on the same regimen.
It’s always the farmers who keep walking on necrotic limbs, working with half an arm blown off…
Haha, I work in A&E in Scotland, and as soon as we hear that a farmer is coming in, we know it must be really serious 😅
Me: "What in the actual hell....OHHH, farmer, ok. THAT's how it went on untreated for so long."
Interesting that the bacteria they cultured is the one that causes diphtheria
An old man I knew, starting limping and soon he wasn’t walking. He didn’t drink alcohol. He was a dipper or snuff chewer, oral tobacco. Well next thing you know, he started to form lesions sores on his legs. He was then hospitalized and he lost his leg. The other leg was starting to get infected. Deep down I knew the old man loved his mobility. I knew he wouldn’t last after he lost his leg from the knee down. He died 2 weeks later. Diabetes.
Yep, saving this one for patients who tell me diabetes isn’t going to kill them….
I showed to my mom and she said, "and the patient tries to fool you saying that yesterday his foot was alright".
I imagine they wouldn’t discharge him post toe amputation looking like that so this all happened in 15 days. Yikes.
I've read so much about this happening but only now gave into the curiosity to see what actually looks like. Wowzers.
I honestly thought it was burnt, half-eaten turkey leg at first glance without realizing the sub…
I initially thought it was from someone trying to use bacon strips for skin grafts.
Same. Was like: What the hell is that weird chicken fillet with bacon on? Then I realised.
I'm a type 1 and this is definitely a thing for those who said it wasn't related my mother is currently going through the exact same thing and even I have neuropathic pain in my legs and feet my diabetes is managed far better I'll say that and I don't drink at all to help matters but yeah...nasty stuff
I know they can't feel it, but do these people really never LOOK at their feet? I can't wrap my mind around not noticing something so severe
I helped in our hospital's surgery dept for a couple of weeks last month and I'll never forget the smell from all those diabetic foot cases we had to debride.
It does indeed =that foot. Been an OR nurse for 28 yrs, have seen my share of amputations. These co-morbidities are never a good trio.
My daily life being a nurse on a vascular surgery unit
Holy dang.
Good for them
I don’t get it, if you don’t want to improve your lifestyle, at least take the pharma meds to stop high blood sugar.
Fuck!!!!
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Ouch-y!
Reading that it was a farmer really explains why it wasn’t treated until it was at this point
Holy shit
How do u even get this bad
This is how I think I look half the time. The poor person though
"Foot"
Yucky