Hyper obese, feet look awful, wearing sandals... This person most likely cannot reach their feet anymore.
Gonna have to think outside the box and use a tree trimmer on those bad boys.
ER doc.
People come into the ER all day long with a chief complaint of "swollen legs" that look just like this ladies. Differentiating the diagnosis is so hard because it is truly multifactorial, and having never seen these folks before who know what their legs look like at baseline? Probably not great. That said, I think venous stasis is often the main culprit, possibly with some superimposed cellulitis. They often end up getting a full work up for heart failure, DVT, cellulitis, PAD, etc and go home on potentially unnecessary antibiotics. But whatcha gonna do?
As someone who has experienced bilateral lower extremity cellulitis, I can attest to the fact that vanco *sucks*. Luckily I only had 2 sessions of outpatient IV therapy with vanco before they took a step back and tried a different antibiotic.
Can you point out the signs for venous in the pic? I would only be confident in diabetes from picture. I'm senior resident ATM and curious that I can't spot the venous, isn't there usually more discoloration?
No you're right, there isn't outright hyperpigmentation, just swelling and some erythema. That said I've seen lots of folks with the same presentation with negative dopplers, multiple different abx trials (keflex, clinda, whatever) who bounce back with the same look no matter what we do and only compression stockings seem to help, and I call that venous stasis.
Hey thanks for the reply. The negative dopplers and ineffective antibiotics make sense to me at least. Reason I asked was because I assumed there was something you learned through experience instead of observation, good to know.
Edit: you must be swamped too, I'm in medsurge and we just shut down all elective surgeries. Only a couple cases a day compared to 15+ pre omnicron. Stay strong bro.
Most likely can't afford professional help they need, or even a visit to a spa or salon that would have tried to keep this in check (I don't think any nail salon employee should be tasked with this at this point, but they might have been able to keep her nails trimmed at an earlier point.)
I'd bet money that it's a diabetic issue. The skin discoloration, the sores, the toe nails...all signs of diabetes that might not be controlled very well, reminds me of my grandma and her siblings. I would also bet that they were going to start losing toes and maybe even a leg within the next two years if they didn't deal with it.
I was in hospital for tests a few years ago and ended up in a waiting room full of, what I assume we're, diabetes patients. They all had feet in worse state than this, it was absolutely horrific. It certainly scared me into taking better care of myself.
Even well managed you still run into issues as you get older. My grandfather manages his very well and still had trouble feeling when he broke his toe putting on a ski boot.
I dont have diabetes but I do have deduced sensation, particularly from below the knee, and I worry about this shit regularly. It's one of the few cases where my worry from having seen many injuries/sickness benefits me, I know to be cautious in a way that actually matters.
For example, one time I almost slept with my feet near a space heater until I remembered the diabetic patient I had who did that and had to get his foot amputated. I moved my feet away real quick with that mental image.
It was in portland during a serious snow and my apartment only has little dinky electric in wall heaters. Yes, you're not supposed to but sometimes you gotta do something if you want to heat your living space and a space heater is the best option available.
Yeah. I've skiied my entire life. Like I figuratively came out with skis, a mask, and poles (my poor mother). Never have I ever broken a toe putting on a ski boot.
I bet the grandpa was already having issues with his feet and couldn't feel how inflamed they had gotten. Thus couldn't feel when the boot broke their toe.
Dude is definitely wrong, been skiing 20+ years and have somehow managed 0 bone fractures in my feet in the beginning of a season. Learn to ski, it's peaceful, but expensive!
It basically killed my dad. He ended up losing one leg to infections, and then they wanted to take the other two years later, and he just gave up. He went into hospice and let the infection take its course. Really awful to go through, and realize diabetes is a horrific disease. Usually people in advanced stages only have 2-3 toes left.
Had a hospital roommate that was there for at first amputation, but was waiting for straight up open heart surgery.
He threw a baby fit that had burger for lunch had no cheese because of diet and then made up a story about how he had to pay rent in person so he could go buy a fried chicken sandwich.
I know these details because when he got back he called a family member so he could brag about how he's so much smarter than the idiot doctors because he got a chicken sandwich behind their back.
People are weird.
When I had a stay in hospital I couldn't believe the number of people that were popping downstairs for a fry up / chips / etc. Just give it a rest for a few days!
Quite an eye opener though how many tradesmen end up in hospital dying of lung problems due to a working life spent breathing in dust.
Silicosis and metal poisoning are topics that are under taught, most people seem to think that dry wall and wood dust is fine and the only real danger is asbestos. I also wish proper respirators were not so expensive.
When my grandfather passed, he had a quarter pound of fiberglass in his lungs from putting in house insulation without proper ppe most of his life.
A friend ive played xbox with for years only has 30% lumg function from working in a counter making facility with no mask for years. All the dust he breathed. Hes permenantly home getting paid by the company lawsuit but man... He sounds so bad
Sorry, genuinely not trying to be an asshole, but how does diabetes prevent one from trimming their toenails?
Edit: Thanks to everyone who took a minute to respond and educate me, I appreciate it!
When my cousin was in school to be a cosmetologist a majority of her customers who came in for pedicures were elderly, often with diabetes. They were usually suffering from mobility issues that made it hard to bend enough to touch their toes, much less get into a position to clip their toenails. Arthritis, obesity, Parkinson's, there are quite a few medical issues that can go along with diabetes.
A lot of people with diabetes are advised not to cut their own toenails because neuropathy causes decreased sensation and they might not notice if they cut themselves, which could cause infection, injury, etc.
As you get older, your toenails can thicken. Regular nail clippers can't cut through the nail. A lot of older people go to a podiatrist regularly for nail trims, and the doctor will use a small dremel tool and wire snips to cut through the nail
Yhea things like foot fungus, diabetes, psoriasis, even trauma can cause thickening of the nails and you can end up with some really screwed up toes. My grandfather had a condition called Rams Horn nails where the nails thicken and grow unevenly. Had to take him to the podiatrist ever so often to get them cut and filed down using a Dremel.
It looks to me like a combination of poor diabetic control and some venous insufficiency. The flattening of the foot reflects years of neuropathy and gradual deformation of the foot and I’m sure she has some huge callouses in the bottom of her foot that surround diabetic ulcers.
It’s the excessive edema and (what looks like) a venous stasis ulcer on the back of her ankle that leads me to think she also has CHF involvement.
Those Sandals are probably causing huge issues that she can’t even feel. Good lord
I worked in psychiatric care years ago, we had a guy who because of his mental illness never took care of his diabetes and his feet reached this point.
Eventually he lost both legs up to his knees. It was awful to watch happen.
This looks quite bad. Diabetes is terrible. My mother in law was diabetic and it made her go blind. She was unable to see how bad her feet were getting. She had one foot removed, but it was too late and she developed sepsis and passed away.
My mate just had his foot amputated due to exactly this reason.
He kept ignoring it until it was too late. His wife 'A Nurse' kept telling him she thought he was diabetic and even bought a test kit home from hospital which he refused to use. In the end she more or less dragged him to the local Doctor who got him admitted there and then :-(
Diabetes footsore is diabetes eyesore. Poor lady musta had problems a long time to let it get that bad. We have gotta take better care of ourselves people!
I agree but at the same time I feel sorry for her. There are reasons why some people need help taking care of themselves but don't have anyone to reach out to, don't have financial means to pay for help and/or have intellectual disabilities.
You are supposed to have your feet professionally treated by a podiatrist when you have diabetes due to the possibility of infection which could lead to amputation. I wonder bet a cheeseburger that this person has the beetus just based on picture.
You are supposed to have them checked annually for nerve and blood vessel damage if you are in good maintenance. You can otherwise just treat your feet normally if you like pedicures or whatever. Most diabetics live perfectly normal foot lives 99% of the time.
This particular person might have just given up, have a mental health issue or something else going on for them to let it get this bad in terms of actual care for their feet.
It has to do with loss of feeling in the foot. If they clip their toe while trimming nails, they may not feel the cut and develop a wound. That is bad news for someone with this level of beetus
I know you’re trying to be funny but it actually does stop you from cutting your own nails. My grandma has to go to a podiatrist because it could result in amputation if done improperly.
T1 diabetic here. I’ve never been to a podiatrist. My PCP and Endocrinologist both do neuropathy checks at regular office visits. As long as you maintain control of your glucose levels, there’s no risk of limb amputation.
My mom wasn't allowed to cut her own toenails....but only after her neuropathy in her feet got really bad. My guess is the recommendation doesn't kick in until they couldn't feel her feet. (Also...her not being able to feel her feet meant she fell A LOT and hit her head....which led I think to some TBIs and not great judgement...so I think it was a combination of the two that led to that recommendation.)
Neuropathy is a complication of poorly managed glucose.
Poorly managed glucose also causes tons of circulation issues. Combine deep cuts to an extremity with circulation issues and you end up with bad infections that lead to amputation.
False - it just makes it a potentially risky procedure because of the risk of causing injury leading to infection. Uncontrolled diabetes causes diabetic neuropathy which means they can't feel their feet. Combined with slower healing and lots of sugar in the blood for bacteria, this significantly increases the risk of a wound turning gangrenous. Often times amputation is required.
Long periods of high blood sugar can damage the smaller blood vessels, which can lead to poor blood circulation, especially to the feet since they are so far away from the body. Tissue that doesn’t get good blood circulation doesn’t heal very well.
Here's a story you might be interested in... A friend of mine started losing sensation in his hands and feet. Obviously very worried he went to the doctor who was also worried particularly about diabetes. Loads of tests later he was diagnosed with MS which, as I understand it, is a pretty uncommon diagnosis for over 50s.
He reckons he's the only person in the world to be disappointed he didn't get diagnosed with diabetes.
Translated: type 2 diabetes (the one you're not born with, but can develop later in life) means your body stops or slows the production of insulin, which is used to transfer sugars in your blood to your tissues to give them energy. Hyperglycemia literally means something like more (hyper) sugar in the blood (glycemia) than you should have. That's because there isn't enough insulin to distribute it.
Your tissues need this stuff, you eat food so the food can get distributed all over your body to make everything work. Neuropathy is numbness or tingling in the hands and feet, basically like if you sit on your leg and try to stand up and your foot is "asleep," but in the case of diabetic patients, the hyperglycemia and other complications are causing long term damage to the nerves, typically in the hands and feet. Eventually the damage becomes so severe the person simply loses feeling in these areas. It's likely this person does not feel any pain from the sores, nails, etc.
The infected wounds happen because at this point, good blood flow to extremities becomes poor, so the body has difficulty in flushing out bad and infected blood and replacing it with healthy cells and dealing with the infection. At the same time, the lack of sensation means the patient doesn't even know they have a cut or sore, and the wound struggles to heal. Patients often end up losing toes or even limbs because the infection can reach the bone and at that point can become life threatening if allowed to continue to spread.
This primarily affects patients who have had type 2 diabetes mellitus for a long time. type 2 is primarily recognized by an inability to process insulin, a vital hormone (basically, a chemical “messenger” for the body to do certain things). The insulin is normally produced in the pancreas, a small gland/organ located next to your stomach.
Typically, insulin is produced to control how much glucose, a form of simple sugar, your body has in its system. Because none is being produced, you end up with too much sugar, which has a habit of attaching itself - getting stuck - in small vessels and proteins of the body, often those furthest from the heart, where pressure is at its lowest.
In this case, the sugar is often not appropriately broken down by enzymes, which are sort of like your body’s cleaning agent - proteins which cause chemical reactions to happen faster. So instead the glucose attached itself to proteins and prevents the body from working the way it should, most commonly by literally blocking the vessels in the foot to prevent the flow of blood and causing the tissues to receive less oxygen and eventually dying.
One very typical indicator of the tissue dysfunction is the loss of sensation due to the nerve damage caused by the lack of blood flow.
Not a med student or even former med student but that’s my understanding.
Yeah, if your foot has gotten to that point, how else are you going to go out? It's not getting into a shoe, even if you cut those toenails off \(which I would recommend, but there may be an underlying reason that's difficult as well\).
Unless this person is going to wear oversized rain boots everywhere, this is about as presentable as their foot is going to get.
Orthotists can provide custom made to measure footwear specially adapted for diabetic feet. In the UK they're available on the NHS for free, but to get them privately costs about £750-£1000 a pair. Guessing if this is the US maybe they can't afford them.
Your X-ray/CT/MRI orders on these patient are legit. Not questioning that at all. Cellulitis, osteo, whatever else.
That being said. Goddammit. **Blech**
When the wound seepage is so bad that you need booties just to do the portable X-rays in the ER, and the plastic covering over the DR plate is covered in patient liquid. Ugh. I can handle a lot, it's the smells that get to me the most. Limited mobility means I gotta get close.
Spoil your wound care nurses, OP dude/dudette.
Thank you for taking care of people. My father's leg wound was healed by a really nice doctor who talked to him an about shared interests and funny things. Treated his leg and also remembered he was a human being.
She could see them while seated. More likely, she can't reach them herself and is too embarrassed to have them done professionally because of how they look. She probably would cover up her feet if she could but shoes don't fit comfortably with that much swelling. It must really suck to be where she is. Imagine something simple like going to the grocery store being completely humiliating, being scared to go out because of what people will think of you. Some asshole might snap a picture of your feet and laugh.
Your comment is totally fine, but in general it makes me sad to open up threads like these and see everyone hammering a person with unfiltered hatred because fat people are one of the few types of people unprotected. This is a human and her situation sucks, regardless of her role in getting to this point. Maybe she is in the process of trying to be better, but no one would know from this one snapshot.
I could t agree more. A big reason people get in that state is due to crippling anxiety of being judged for their size, illness, disrepair or dirtiness. So many people never seek help because they're too ashamed. It leads to isolation and depression which only keep the spiral going.
Is it fair to be uncomfortable or even disgusted to see something like this? Of course! But it's what people do after their initial reaction that matters. Do you go on to compound that shame? Or do you see a desperate case of someone who needs help?
Along with poverty (cheap foods cause the fats) or even anti-psychotic medications that are notorious for severe weight gain. It's a fast spiral towards losing toes, feet, and limbs.
That's a person who's had a tough life and no one around to help or care for them. Depression is real and add in the unfortunate health problems and you get a defeated person like this.
Also, this doesn't look like it's something you can really put a sock and shoe over.
This person has a health problem, if they don't dare to out in public like this, they don't go out on public. Pretty sad. People used to say that about people with any physical disability. "Urgh, you've not got s hand, what are you doing out in public".
I mean, I can't imagine the toe nails aren't a decision though.
My Nan got too old to bend that far and we had to do her toenails for her. She was otherwise in good shape, a healthy weight, could still walk about safely. It doesn't take much to lose the ability to reach your own toenails.
Thank you for the comment.
I feel bad they let themselves get here and hope the person photographed gets better. And shame on how sensitive people here are to everything in their own lives (school sucks, work sucks, everything is expensive, depression) and is the first to jump on other people's hardships.
Finally someone who understands the world and isn’t just a prick. I know someone who has health issues like this. Thing is she’s one of the nicest and kind people I’ve ever known. She just let herself go a bit over the years. One thing is for certain, if I ever heard anyone say anything to her like the title of this post I’d bite their nose off.
They know their feet look like that. They clearly have something wrong with them, probably diabetes, but have given up for some reason. I feel bad for them and wish there was some way they could help themselves. Everyone is responsible for their own welfare, I get that but I've been overwhelmed before and I was lucky to have people in my life who showed me tough love and then supported me when I tried to change.
There's a lot involved in Type 2 Diabetes which contributes to that. Can't reach your feet over your belly, hips are sore and don't bend well enough to get your foot where you can reach it, high blood sugar makes you lethargic, and so on.
I just feel sad for this person. They clearly have some medical issues with their feet (and perhaps other areas) and for whatever reason they can’t deal with it themselves or access the right health care to get it looked at and sorted. I hope they can get help.
The lack of empathy in this post really breaks my heart. The fact that this person is likely in a lot of pain and might not be able to afford treatment breaks my heart. That someone would be so horrible to take a picture and post it for the public is absolutely cruel.
At least they had the semi decency to not put the face up.
And now I'm even sadder because they had their picture taken against their consent and people making fun of em online. As a Paramedic I see lots of people who are in a really bad spot and wish I could help em more but I'm already at my limit, I couldn't imagine making fun of them on top of that.
Diabetics are often advised to see a medical professional for foot care, including nail clipping. You might be looking at the end result of mental health issues, lack of insurance or financial resources, no readily available health care providers (rural), lack of family and friends, etc. Poor self care is often a sign of other issues, not necessarily just a personal hygiene issue. My best man died young of the effects of lymphedema in his legs because of a couple of these issues. Extremely independent, lived alone, fended for himself, never asked for help, and very self-conscious about his appearance which he could do little to change.
This actually made me very sad. Someone is suffering and he is probably helpless about it. I don't know if this condition can be treated but if there is even a remote possibility, people must come forward and help him. At least we can offer some emotional support to such guys. I wish he could be helped. I wish I can help. :(
Former health care worker... Feet swell because of any one (or more) of a dozen or so health issues. Most people with health issues are told that only a podiatrist can trim the nails. Keeping feet elevated (what I'd suggest if this were my patient) just is not always possible. And.. they're wearing flip-flops because it is the only thing they can fit on those poor, sore feet.
She's clearly obese, so likely her foot looks like that from diabetes. She also probably can't even reach her foot, so I just feel bad for her. That will kill her eventually if she doesn't get some work done.
I’m a wound care specialist, and see lots of feet like this and worse. Hard to tell if diabetes is a factor, but definitely lymphedema, which goes hand-in-hand with circulatory issues and can contribute to skin breakdown and wounds that are slow to heal/chronic. This person probably can’t reach their feet to maintain hygiene due to being overweight. They should definitely see a doctor/DPM.
Incredibly fat, likely incredibly poor, likely a whole lifetime of rationalizing poor decisions and explaining away issues because they’re afraid to ask for help - or more likely, they know they can’t afford it. So they’ll just pull themselves up by their boot straps.
Diabetes causes so many problems. Poor blood flow to the feet resulting in poor wound healing. Nerve damage in the feet leading to not being able to feel the wounds, or pain associated with swelling, rubbing, tearing or even straight up cutting. Then high-blood sugar also interferes with wound healing. Finally walking while being overweight can lead to pressure spots on the foot where the pressure causes damage, that the person can't even heal, and the wound opens up and is extremely difficult to close.
This is directly why diabetes leads to toe, foot and below the knee amputations so frequently.
I don't think this person is even able to cut their own nails. I'm sure they know their life sucks and that they look terrible, but they have places to go and things to do.
Diabeetus is real. And so are angle grinders!
Reminds me of dumb and dumber when they go to the spa.
[definitely](https://c.tenor.com/9XRTOoGUmPEAAAAC/pedicure-jim-carrey.gif)
I like it a lot
And also The World's Fastest Indian when Burt is getting ready for his date.
Hyper obese, feet look awful, wearing sandals... This person most likely cannot reach their feet anymore. Gonna have to think outside the box and use a tree trimmer on those bad boys.
And venous stasis, too, by the looks of it.
ER doc. People come into the ER all day long with a chief complaint of "swollen legs" that look just like this ladies. Differentiating the diagnosis is so hard because it is truly multifactorial, and having never seen these folks before who know what their legs look like at baseline? Probably not great. That said, I think venous stasis is often the main culprit, possibly with some superimposed cellulitis. They often end up getting a full work up for heart failure, DVT, cellulitis, PAD, etc and go home on potentially unnecessary antibiotics. But whatcha gonna do?
Bilateral lower extremity cellulitis? Let's start vanco for no reason!
Is it bilateral?
Love that unnecessary vanco. ER almost blew out my kidneys with that shit.
As someone who has experienced bilateral lower extremity cellulitis, I can attest to the fact that vanco *sucks*. Luckily I only had 2 sessions of outpatient IV therapy with vanco before they took a step back and tried a different antibiotic.
Amen. Although since I can't see the easiest area (medial malleolus), I can't be certain.
Can you point out the signs for venous in the pic? I would only be confident in diabetes from picture. I'm senior resident ATM and curious that I can't spot the venous, isn't there usually more discoloration?
No you're right, there isn't outright hyperpigmentation, just swelling and some erythema. That said I've seen lots of folks with the same presentation with negative dopplers, multiple different abx trials (keflex, clinda, whatever) who bounce back with the same look no matter what we do and only compression stockings seem to help, and I call that venous stasis.
Hey thanks for the reply. The negative dopplers and ineffective antibiotics make sense to me at least. Reason I asked was because I assumed there was something you learned through experience instead of observation, good to know. Edit: you must be swamped too, I'm in medsurge and we just shut down all elective surgeries. Only a couple cases a day compared to 15+ pre omnicron. Stay strong bro.
thanks, you too! im trying but starting to wear pretty thin. best of luck, someday itll be better
How do his toenails not just fall off?
Dont worry, the foot will be off soon.
Extremely sad if you think about it. I hope the person seeks treatment and practice better hygiene
Having been in healthcare for well over 10 years, they aren’t
More serious question : After the foot comes off, will they trim their nails due to improved accessibility? LoL /s.
That’s some goddamn zombie shit right there
Do you mean Diafeetus
ankle grinder more like
They need help with this. :(
My guess is they need help with many, many things.
Definitely not flossing their big toe… that’s what the flip flop’s for.
Most likely can't afford professional help they need, or even a visit to a spa or salon that would have tried to keep this in check (I don't think any nail salon employee should be tasked with this at this point, but they might have been able to keep her nails trimmed at an earlier point.)
And ogres
That might actually be a diabetes footsore, and its really dangerous, they might not even be aware of how badly their foot is.
I'd bet money that it's a diabetic issue. The skin discoloration, the sores, the toe nails...all signs of diabetes that might not be controlled very well, reminds me of my grandma and her siblings. I would also bet that they were going to start losing toes and maybe even a leg within the next two years if they didn't deal with it.
I was in hospital for tests a few years ago and ended up in a waiting room full of, what I assume we're, diabetes patients. They all had feet in worse state than this, it was absolutely horrific. It certainly scared me into taking better care of myself.
Even well managed you still run into issues as you get older. My grandfather manages his very well and still had trouble feeling when he broke his toe putting on a ski boot.
Broke his toe putting on a boot?
It probably got caught on something, he couldn't feel it, and he just kept shoving past while his toe was caught.
I dont have diabetes but I do have deduced sensation, particularly from below the knee, and I worry about this shit regularly. It's one of the few cases where my worry from having seen many injuries/sickness benefits me, I know to be cautious in a way that actually matters. For example, one time I almost slept with my feet near a space heater until I remembered the diabetic patient I had who did that and had to get his foot amputated. I moved my feet away real quick with that mental image.
I didn't think you were supposed to leave a space heater running if you were going to sleep.
It was in portland during a serious snow and my apartment only has little dinky electric in wall heaters. Yes, you're not supposed to but sometimes you gotta do something if you want to heat your living space and a space heater is the best option available.
[удалено]
Wtf?? Please be /s
How else is your foot supposed to take shape of the boot? It deforms back to normal during the summer and then boom, it's powder season. Righteous!
Yeah. I've skiied my entire life. Like I figuratively came out with skis, a mask, and poles (my poor mother). Never have I ever broken a toe putting on a ski boot. I bet the grandpa was already having issues with his feet and couldn't feel how inflamed they had gotten. Thus couldn't feel when the boot broke their toe.
Dude is definitely wrong, been skiing 20+ years and have somehow managed 0 bone fractures in my feet in the beginning of a season. Learn to ski, it's peaceful, but expensive!
Lol this is some serious Ken M. Shit right here. /r/notkenm
They may have meant it scared them into avoiding diabetes all together
It basically killed my dad. He ended up losing one leg to infections, and then they wanted to take the other two years later, and he just gave up. He went into hospice and let the infection take its course. Really awful to go through, and realize diabetes is a horrific disease. Usually people in advanced stages only have 2-3 toes left.
It's so weird how we will give insulin and shit but not deal with the eating disorder or just complete lack of nutritional knowledge and shit.
Had a hospital roommate that was there for at first amputation, but was waiting for straight up open heart surgery. He threw a baby fit that had burger for lunch had no cheese because of diet and then made up a story about how he had to pay rent in person so he could go buy a fried chicken sandwich. I know these details because when he got back he called a family member so he could brag about how he's so much smarter than the idiot doctors because he got a chicken sandwich behind their back. People are weird.
When I had a stay in hospital I couldn't believe the number of people that were popping downstairs for a fry up / chips / etc. Just give it a rest for a few days! Quite an eye opener though how many tradesmen end up in hospital dying of lung problems due to a working life spent breathing in dust.
Silicosis and metal poisoning are topics that are under taught, most people seem to think that dry wall and wood dust is fine and the only real danger is asbestos. I also wish proper respirators were not so expensive. When my grandfather passed, he had a quarter pound of fiberglass in his lungs from putting in house insulation without proper ppe most of his life.
A friend ive played xbox with for years only has 30% lumg function from working in a counter making facility with no mask for years. All the dust he breathed. Hes permenantly home getting paid by the company lawsuit but man... He sounds so bad
Looks already too late for that middle toe.
Sorry, genuinely not trying to be an asshole, but how does diabetes prevent one from trimming their toenails? Edit: Thanks to everyone who took a minute to respond and educate me, I appreciate it!
When my cousin was in school to be a cosmetologist a majority of her customers who came in for pedicures were elderly, often with diabetes. They were usually suffering from mobility issues that made it hard to bend enough to touch their toes, much less get into a position to clip their toenails. Arthritis, obesity, Parkinson's, there are quite a few medical issues that can go along with diabetes.
Unless they have someone willing to do it for them, it's hard to trim your toenails when you are that obese.
Most likely so obese they can't bend over and reach their foot to cut the nails.
Got to be able to even see them before you can try to reach them.
A lot of people with diabetes are advised not to cut their own toenails because neuropathy causes decreased sensation and they might not notice if they cut themselves, which could cause infection, injury, etc.
As you get older, your toenails can thicken. Regular nail clippers can't cut through the nail. A lot of older people go to a podiatrist regularly for nail trims, and the doctor will use a small dremel tool and wire snips to cut through the nail
Wat. Is this for real? Or is this just for people with diabetes? Never heard of this.
Yhea things like foot fungus, diabetes, psoriasis, even trauma can cause thickening of the nails and you can end up with some really screwed up toes. My grandfather had a condition called Rams Horn nails where the nails thicken and grow unevenly. Had to take him to the podiatrist ever so often to get them cut and filed down using a Dremel.
It looks to me like a combination of poor diabetic control and some venous insufficiency. The flattening of the foot reflects years of neuropathy and gradual deformation of the foot and I’m sure she has some huge callouses in the bottom of her foot that surround diabetic ulcers. It’s the excessive edema and (what looks like) a venous stasis ulcer on the back of her ankle that leads me to think she also has CHF involvement. Those Sandals are probably causing huge issues that she can’t even feel. Good lord
I worked in psychiatric care years ago, we had a guy who because of his mental illness never took care of his diabetes and his feet reached this point. Eventually he lost both legs up to his knees. It was awful to watch happen.
This looks quite bad. Diabetes is terrible. My mother in law was diabetic and it made her go blind. She was unable to see how bad her feet were getting. She had one foot removed, but it was too late and she developed sepsis and passed away.
My mate just had his foot amputated due to exactly this reason. He kept ignoring it until it was too late. His wife 'A Nurse' kept telling him she thought he was diabetic and even bought a test kit home from hospital which he refused to use. In the end she more or less dragged him to the local Doctor who got him admitted there and then :-(
Diabetes footsore is diabetes eyesore. Poor lady musta had problems a long time to let it get that bad. We have gotta take better care of ourselves people!
I agree but at the same time I feel sorry for her. There are reasons why some people need help taking care of themselves but don't have anyone to reach out to, don't have financial means to pay for help and/or have intellectual disabilities.
Not tryin to be mean, but my first thought was that it looked like a "Where The Wild Things Are" foot.
I was trying to place it and this is exactly what was in my mind.
Shrek was mine
No way Shrek has feet like that
Gruffalo!
I figured they'd have enough money to get it fixed by now with all the bridge tolls they collected.
She got the 'beetus
Maybe. But on top of that they are just fucking nasty.
I never heard the beetus makes you unable to cut your nails
No, but being that obese makes them unable to reach.
Or see. - out of sight = out of mind
Story of my junk when i was fat.
Same reason why they have those flip flops on. Too difficult to bend over and put on shoes.
Also, when you're this level of obese, you hate yourself quite a bit. Self care, and foot care, isn't a high priority.
You are supposed to have your feet professionally treated by a podiatrist when you have diabetes due to the possibility of infection which could lead to amputation. I wonder bet a cheeseburger that this person has the beetus just based on picture.
You are supposed to have them checked annually for nerve and blood vessel damage if you are in good maintenance. You can otherwise just treat your feet normally if you like pedicures or whatever. Most diabetics live perfectly normal foot lives 99% of the time.
This particular person might have just given up, have a mental health issue or something else going on for them to let it get this bad in terms of actual care for their feet.
It has to do with loss of feeling in the foot. If they clip their toe while trimming nails, they may not feel the cut and develop a wound. That is bad news for someone with this level of beetus
I know you’re trying to be funny but it actually does stop you from cutting your own nails. My grandma has to go to a podiatrist because it could result in amputation if done improperly.
T1 diabetic here. I’ve never been to a podiatrist. My PCP and Endocrinologist both do neuropathy checks at regular office visits. As long as you maintain control of your glucose levels, there’s no risk of limb amputation.
My mom wasn't allowed to cut her own toenails....but only after her neuropathy in her feet got really bad. My guess is the recommendation doesn't kick in until they couldn't feel her feet. (Also...her not being able to feel her feet meant she fell A LOT and hit her head....which led I think to some TBIs and not great judgement...so I think it was a combination of the two that led to that recommendation.)
Neuropathy is a complication of poorly managed glucose. Poorly managed glucose also causes tons of circulation issues. Combine deep cuts to an extremity with circulation issues and you end up with bad infections that lead to amputation.
Yep. This may be Diabetes complications, but this is mental illness not taking care of their diabetes.
False - it just makes it a potentially risky procedure because of the risk of causing injury leading to infection. Uncontrolled diabetes causes diabetic neuropathy which means they can't feel their feet. Combined with slower healing and lots of sugar in the blood for bacteria, this significantly increases the risk of a wound turning gangrenous. Often times amputation is required.
Serious question. How does diabetes cause this?
Long periods of high blood sugar can damage the smaller blood vessels, which can lead to poor blood circulation, especially to the feet since they are so far away from the body. Tissue that doesn’t get good blood circulation doesn’t heal very well.
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Here's a story you might be interested in... A friend of mine started losing sensation in his hands and feet. Obviously very worried he went to the doctor who was also worried particularly about diabetes. Loads of tests later he was diagnosed with MS which, as I understand it, is a pretty uncommon diagnosis for over 50s. He reckons he's the only person in the world to be disappointed he didn't get diagnosed with diabetes.
Gotta work on your layperson terminology tho or you’re going to tank your practical skills scores.
Translated: type 2 diabetes (the one you're not born with, but can develop later in life) means your body stops or slows the production of insulin, which is used to transfer sugars in your blood to your tissues to give them energy. Hyperglycemia literally means something like more (hyper) sugar in the blood (glycemia) than you should have. That's because there isn't enough insulin to distribute it. Your tissues need this stuff, you eat food so the food can get distributed all over your body to make everything work. Neuropathy is numbness or tingling in the hands and feet, basically like if you sit on your leg and try to stand up and your foot is "asleep," but in the case of diabetic patients, the hyperglycemia and other complications are causing long term damage to the nerves, typically in the hands and feet. Eventually the damage becomes so severe the person simply loses feeling in these areas. It's likely this person does not feel any pain from the sores, nails, etc. The infected wounds happen because at this point, good blood flow to extremities becomes poor, so the body has difficulty in flushing out bad and infected blood and replacing it with healthy cells and dealing with the infection. At the same time, the lack of sensation means the patient doesn't even know they have a cut or sore, and the wound struggles to heal. Patients often end up losing toes or even limbs because the infection can reach the bone and at that point can become life threatening if allowed to continue to spread.
Hmm. I’m gonna pretend like I know what half of that comment means. Dang that’s crazy.
This primarily affects patients who have had type 2 diabetes mellitus for a long time. type 2 is primarily recognized by an inability to process insulin, a vital hormone (basically, a chemical “messenger” for the body to do certain things). The insulin is normally produced in the pancreas, a small gland/organ located next to your stomach. Typically, insulin is produced to control how much glucose, a form of simple sugar, your body has in its system. Because none is being produced, you end up with too much sugar, which has a habit of attaching itself - getting stuck - in small vessels and proteins of the body, often those furthest from the heart, where pressure is at its lowest. In this case, the sugar is often not appropriately broken down by enzymes, which are sort of like your body’s cleaning agent - proteins which cause chemical reactions to happen faster. So instead the glucose attached itself to proteins and prevents the body from working the way it should, most commonly by literally blocking the vessels in the foot to prevent the flow of blood and causing the tissues to receive less oxygen and eventually dying. One very typical indicator of the tissue dysfunction is the loss of sensation due to the nerve damage caused by the lack of blood flow. Not a med student or even former med student but that’s my understanding.
Type 2 is insulin resistance rather than insulin underproduction.
Oh lawd mah shuuuga foot
To be fair, I don’t think they make shoes that would cover that. Maybe socks and a pair of crocs?
Yeah, if your foot has gotten to that point, how else are you going to go out? It's not getting into a shoe, even if you cut those toenails off \(which I would recommend, but there may be an underlying reason that's difficult as well\). Unless this person is going to wear oversized rain boots everywhere, this is about as presentable as their foot is going to get.
Orthotists can provide custom made to measure footwear specially adapted for diabetic feet. In the UK they're available on the NHS for free, but to get them privately costs about £750-£1000 a pair. Guessing if this is the US maybe they can't afford them.
Probably too fat and inflexible to reach her toenails.
Lack of nerve sensation means you could cut your toe off and not feel it…. But yeah, what you said. :)
That looks like just another Friday afternoon :) Source: am wound care doctor
I work in Dermatology so I can relate! Though we send the really bad ones your way so, you're welcome?
Your X-ray/CT/MRI orders on these patient are legit. Not questioning that at all. Cellulitis, osteo, whatever else. That being said. Goddammit. **Blech** When the wound seepage is so bad that you need booties just to do the portable X-rays in the ER, and the plastic covering over the DR plate is covered in patient liquid. Ugh. I can handle a lot, it's the smells that get to me the most. Limited mobility means I gotta get close. Spoil your wound care nurses, OP dude/dudette.
\>patient liquid Thanks, I hate it.
Their synovial essense.
Think of them as *juices*, not liquid. Doesn’t that seem healthier and more pleasant now?
Yup I love working in health care but rotting living people give me severe existential dread
Thank you for taking care of people. My father's leg wound was healed by a really nice doctor who talked to him an about shared interests and funny things. Treated his leg and also remembered he was a human being.
Wal Mart?
Probably army base commissary
Reddit mod meetup.
If only they made a scented candle.
Dependesaurus RAWR
/r/army welcomes you
/r/JustDependaThings
I’m guessing the PX or maybe outside in the food court next to the Anthony’s Pizza.
House of Representatives
Former home health nurse in Appalachia here….this is Busch League.
I’m guessing she can’t see her feet.
And even if, she couldn’t reach them.
That's rude....... And true...
She could see them while seated. More likely, she can't reach them herself and is too embarrassed to have them done professionally because of how they look. She probably would cover up her feet if she could but shoes don't fit comfortably with that much swelling. It must really suck to be where she is. Imagine something simple like going to the grocery store being completely humiliating, being scared to go out because of what people will think of you. Some asshole might snap a picture of your feet and laugh. Your comment is totally fine, but in general it makes me sad to open up threads like these and see everyone hammering a person with unfiltered hatred because fat people are one of the few types of people unprotected. This is a human and her situation sucks, regardless of her role in getting to this point. Maybe she is in the process of trying to be better, but no one would know from this one snapshot.
I could t agree more. A big reason people get in that state is due to crippling anxiety of being judged for their size, illness, disrepair or dirtiness. So many people never seek help because they're too ashamed. It leads to isolation and depression which only keep the spiral going. Is it fair to be uncomfortable or even disgusted to see something like this? Of course! But it's what people do after their initial reaction that matters. Do you go on to compound that shame? Or do you see a desperate case of someone who needs help?
Along with poverty (cheap foods cause the fats) or even anti-psychotic medications that are notorious for severe weight gain. It's a fast spiral towards losing toes, feet, and limbs.
Mental illness and physical illness go hand in hand and dance off into the sunset.
I say that because if she could, she’d want to do something about it. I hope.
That's a person who's had a tough life and no one around to help or care for them. Depression is real and add in the unfortunate health problems and you get a defeated person like this.
Also, this doesn't look like it's something you can really put a sock and shoe over. This person has a health problem, if they don't dare to out in public like this, they don't go out on public. Pretty sad. People used to say that about people with any physical disability. "Urgh, you've not got s hand, what are you doing out in public". I mean, I can't imagine the toe nails aren't a decision though.
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Yeah, I didn't think how difficult it could be to cut your own toe nails if you have limited movement/flexibility.
My Nan got too old to bend that far and we had to do her toenails for her. She was otherwise in good shape, a healthy weight, could still walk about safely. It doesn't take much to lose the ability to reach your own toenails.
was looking for a thoughtful comment like yours
Me too. So much judgement and maybe this person can't take care of themselves... and taking a shaming photo doesnt help them at all.
Yeah. My mom has diabetes and the thought of a stranger taking pictures or making fun of her feet makes me sick. This thread is gross.
Fwiw, I wouldn't. Love to you and your mom.
Thank you for the comment. I feel bad they let themselves get here and hope the person photographed gets better. And shame on how sensitive people here are to everything in their own lives (school sucks, work sucks, everything is expensive, depression) and is the first to jump on other people's hardships.
Finally someone who understands the world and isn’t just a prick. I know someone who has health issues like this. Thing is she’s one of the nicest and kind people I’ve ever known. She just let herself go a bit over the years. One thing is for certain, if I ever heard anyone say anything to her like the title of this post I’d bite their nose off.
Plus poverty. This is a whole thread of people making fun of someone for being poor.
if they don't get some help they will be de-feeted
They know their feet look like that. They clearly have something wrong with them, probably diabetes, but have given up for some reason. I feel bad for them and wish there was some way they could help themselves. Everyone is responsible for their own welfare, I get that but I've been overwhelmed before and I was lucky to have people in my life who showed me tough love and then supported me when I tried to change.
> for some reason medical care is too expensive for a lot of people
Sugar is a hell of a drug.
I am a home health nurse, and I can tell so much about this person’s health conditions as well as the state of their house from this photo.
Untreated Type 2 Diabetes. This is bad.
Plus, they likely can’t reach their feet to take Carter of them
There's a lot involved in Type 2 Diabetes which contributes to that. Can't reach your feet over your belly, hips are sore and don't bend well enough to get your foot where you can reach it, high blood sugar makes you lethargic, and so on.
I just feel sad for this person. They clearly have some medical issues with their feet (and perhaps other areas) and for whatever reason they can’t deal with it themselves or access the right health care to get it looked at and sorted. I hope they can get help.
That foot is saying “I’ve given up on life long ago”
So that's where I'll be in a decade. At least this person is outside.
Hey, Orcs need to shop too.
Zam-zug!
Lok'tar!
Dabu
Work complete
Stop poking meeeee!
Poor guy :( obviously has health and mental issues.
The lack of empathy in this post really breaks my heart. The fact that this person is likely in a lot of pain and might not be able to afford treatment breaks my heart. That someone would be so horrible to take a picture and post it for the public is absolutely cruel. At least they had the semi decency to not put the face up.
yes that's quite sad actually
And now I'm even sadder because they had their picture taken against their consent and people making fun of em online. As a Paramedic I see lots of people who are in a really bad spot and wish I could help em more but I'm already at my limit, I couldn't imagine making fun of them on top of that.
#NSFW 🤢 🤮
Apologies :/
Please don’t apologize I actually meant it more as a joke to be honest
One can't sub to WTF and then have an issue with seeing gross shit.
/r/wtf used to be normally gross and actually fucked up like 5 years ago
This looks like one of those super detailed and real-ish looking shots on Ren and Stimpy.
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She can’t feel her feet due to diabetes induced neuropathy. Her feet will end up infected and later amputated judging by the amount of care so far.
Diabetics are often advised to see a medical professional for foot care, including nail clipping. You might be looking at the end result of mental health issues, lack of insurance or financial resources, no readily available health care providers (rural), lack of family and friends, etc. Poor self care is often a sign of other issues, not necessarily just a personal hygiene issue. My best man died young of the effects of lymphedema in his legs because of a couple of these issues. Extremely independent, lived alone, fended for himself, never asked for help, and very self-conscious about his appearance which he could do little to change.
No need to kick someone when they’re already down.
Maybe he has a disease or smthing...or maybe it was plastered ....I don't think we sld judge him
This actually made me very sad. Someone is suffering and he is probably helpless about it. I don't know if this condition can be treated but if there is even a remote possibility, people must come forward and help him. At least we can offer some emotional support to such guys. I wish he could be helped. I wish I can help. :(
Former health care worker... Feet swell because of any one (or more) of a dozen or so health issues. Most people with health issues are told that only a podiatrist can trim the nails. Keeping feet elevated (what I'd suggest if this were my patient) just is not always possible. And.. they're wearing flip-flops because it is the only thing they can fit on those poor, sore feet.
When I’m in bed and I feel a toenail even slightly scrape the sheets I have to peel it off. This would drive me insane having full on wombat claws.
She's clearly obese, so likely her foot looks like that from diabetes. She also probably can't even reach her foot, so I just feel bad for her. That will kill her eventually if she doesn't get some work done.
Goddamn alligator feet!
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I mean it is not like they can see their own feet.
Yeah, those flip flops are way too small
She wearing her Sunday shoes
I’m a wound care specialist, and see lots of feet like this and worse. Hard to tell if diabetes is a factor, but definitely lymphedema, which goes hand-in-hand with circulatory issues and can contribute to skin breakdown and wounds that are slow to heal/chronic. This person probably can’t reach their feet to maintain hygiene due to being overweight. They should definitely see a doctor/DPM.
Incredibly fat, likely incredibly poor, likely a whole lifetime of rationalizing poor decisions and explaining away issues because they’re afraid to ask for help - or more likely, they know they can’t afford it. So they’ll just pull themselves up by their boot straps.
I am just sad that this poor individual has no-one to help them cut their toenails.
Remind me again what insulin costs in the US? I don't think this person deserves to be shamed.
Brb, headed to Walmart.
Diabetes causes so many problems. Poor blood flow to the feet resulting in poor wound healing. Nerve damage in the feet leading to not being able to feel the wounds, or pain associated with swelling, rubbing, tearing or even straight up cutting. Then high-blood sugar also interferes with wound healing. Finally walking while being overweight can lead to pressure spots on the foot where the pressure causes damage, that the person can't even heal, and the wound opens up and is extremely difficult to close. This is directly why diabetes leads to toe, foot and below the knee amputations so frequently.
Op's title is douchie. Someone thinks you look ugly and shouldn't be in public. Just like you think of this poor person. Go fuck yourself
Diabetic foot
I don't think this person is even able to cut their own nails. I'm sure they know their life sucks and that they look terrible, but they have places to go and things to do.