Open Abrasian on the Bottom of My Big Toe

Hi!

I have been wearing the same slippers while indoors for years. Suddenly, I just developed an open abrasion on the bottom of my big toe.

First, and probably most urgent question: What should I do about it? (Pointers to evidence are desirable, but not necessary.)

The first thing I would do is make an appointment to see a podiatrist. Then I would carefully wash with soap and water and apply some Neosporin antibiotic ointment and a bandage. I would change that dressing every day.

How is the feeling in the bottom of your feet and toes? Do you still have protective sensation? When was the last time that a doctor performed a foot sensation test (a monofilament or tuning fork)? How long do you think this abrasion was present before you discovered it?

How long have you been diagnosed with diabetes? T1D or T2D? Have you experienced any slow-to-heal wounds in the recent past? How well have you managed your blood sugar levels? How often do you do a fingerstick check? Do you use a continuous glucose monitor? Have you considered getting a CGM?

Sorry - I’ve now asked you more questions than I’ve answered but I suspect the podiatrist will repeat some of the same questions. Foot injuries and open wounds are dangerous for people with diabetes – get to a foot doctor as soon as possible. Tell them you have diabetes and an open wound on your toe.

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I agree with Terry- dont delay, do seek medical attention/see your doctor asap-injury to the diabetic foot is potentially very serious. Best outcomes are often due to early treatment! Going forward, your selection re: footwear(shoes,socks etc) is critical -heres a good Foot health resource link that you may find helpful Diabetes and Your Feet | Diabetes | CDC.
Please also consider professional / medically trained foot wear specialist (like pedothotist) to guide your foot wear purchases for happy, healthy feet-all the best!

The first thing I would do is make an appointment to see a podiatrist.

No live podiatrist within several hours of here, as far as we’ve been able to discover. And the one who died refused to examine things like this, because they weren’t important enough. And yes, my endocrinologist wrote to the management of the HMO to complain about the situation. Well, at least he tried.

Do you still have protective sensation?

Yes, whenever tested, my sensation is either perfect or slightly impaired. At the moment it seems perfect. I did feel the pain of the abrasion.

When was the last time that a doctor performed a foot sensation test (a monofilament or tuning fork)?

Maybe 3 months ago.

How long do you think this abrasion was present before you discovered it?
My guess is that it occurred today. (It’s now night here.)

How long have you been diagnosed with diabetes? T1D or T2D?

T2d, maybe 10 years, maybe more. I could probably check.

Have you experienced any slow-to-heal wounds in the recent past?

Yes, my trigger finger surgery was extremely slow to heal, according to the people who are supposed to know these things. One of my sons, a somewhat snarky 2nd year resident in gynecology, remarks with long strings of obscenities when asked to comment on my healing or recovering from anything. And he also lives about 2 hours from here, and his wife just had a baby. He’ll just tell me to go to the emergency room.

How well have you managed your blood sugar levels?

Depends what one’s expectations are. My last HbA1G was something like 6.3, and hasn’t been above 7 in years.

How often do you do a fingerstick check?

Almost once a day.

Do you use a continuous glucose monitor? Have you considered getting a CGM?

No and no.

I would carefully wash with soap and water and apply some Neosporin antibiotic ointment and a bandage.

Before I saw your answer I put a bandaid with some of one of those povidone-iodine gels on it. I have no mixed topical antibiotic. The closest thing I have is some broad-spectrum antibiotic cream way, way, way past its expiration date.

Thanks a lot.
M.

Hi MS, Your detailed reply offers lots of (positive)insight re your current foot health risk profile. The topical application of the povidine iodine on this open area is totally fine-its broad spectrum, an excellent antimicrobial- as a nurse, we use it as our first line for localized wound infection prevention. I still encourage you to seek access(?“zoom call”) to a doctor or experienced nurse asap - consult with one of them for further assessment/recommendations. Best to have medically trained eyes look at it! Its also very important that the cause/ source of this wound be identified to prevent further injury and potential future recurrence. Likely pressure related…(? you queried your old slippers-dont wear them/find alternative foot wear at this time !) Good luck.

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I’ve never used Zoom, and I know the attitudes of the practitioners around here: If I talk to them by telephone, they’ll want someone to see it in real life anyway. In the meantime, my wife looked at it, and can’t see anything, and I think I’ll have no problem getting an appointment with a professional tomorrow if I’m still worried. I just put another bandaid with povidone-iodine gel back on afterwards.

My second question was going to be about my most-often-used footwear, my slippers, but you’ve already pretty much answered it. Maybe two or three years ago I bought some comfortable slippers and put a sort of aerated rubber liners in them to distribute the pressure. I threw the liners out about a year ago for some reason; I think that they were prone to fall out. This is the first time that anything has gone wrong with foot or feet, and there was no obvious trigger.

I guess that I should either put new liners in or get new slippers and new liners. Agreed? I spend a lot more time at home in slippers than outdoors in shoes. As I hinted, there are no foot-professionals anywhere near here.

Thanks.
M.

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Sounds like you’re not too alarmed with this. I assume that means that your toe is not painful or swollen. Good that your wife was able to look at it. It’s awkward to see the bottom of your feet, even with a mirror.

I would encourage follow-up with a doctor tomorrow, just to be safe. You don’t ever want to hear a doctor ask, “Why didn’t you come in sooner?”

Many people with T2D are often unaware of their diabetes for many years in the beginning. This can be a time when high blood sugar damages feet, eyes, kidneys, and other vital tissue. Going 10 years without a diagnosis and unaware of high blood sugar is not uncommon.

Yeah, I would consider replacing your current slippers with a fresh pair.

I would also check your blood glucose more frequently until this toe injury resolves. Rising and consistently high blood sugar may indicate an infection.

You don’t mention insulin so I assume that you’re not taking any.

Good luck. Please let us know the outcome.

“Sounds like you’re not too alarmed with this.”
Somewhat alarmed.

“I assume that means that your toe is not painful or swollen.”
Slightly painful, not swollen.

“It’s awkward to see the bottom of your feet, even with a mirror.”
I seem to remember reading somewhere about some kind of mirrors with long handles at a strange angle useful for diabetics (and lepers) for looking at the bottom of their feet. Anybody know anything about this? I think I need one lying around the house.

“I would encourage follow-up with a doctor tomorrow, just to be safe.”
I may. Oddly, I shouldn’t have trouble getting hold of a doctor or nurse, even maybe a diabetes nurse, if I want to.

‘You don’t ever want to hear a doctor ask, “Why didn’t you come in sooner?’
Already heard it, years before diabetes. Shut him up in a way which amused both of us.

“Going 10 years without a diagnosis and unaware of high blood sugar is not uncommon.”
How about going 2 years without treatment because I was convinced that the test results were a mistake. I still say that I had logic on my side. Only the facts were against me.

“I would also check your blood glucose more frequently until this toe injury resolves. Rising and consistently high blood sugar may indicate an infection.”
Thanks.

“You don’t mention insulin so I assume that you’re not taking any.”
Toujeo 100U/day and NovoRapid when I think it’s a good idea, often after a fingerstick. Lately more than before. Maybe 20-30-U/day average.

“Good luck. Please let us know the outcome.”
I hope I’ll know a lot more by tomorrow.

Thanks.

Well, it’s hurting again. I was reasonably close to the clinic of my HMO, so I called. The automatic answering gadget said that they had an emergency nurses’ clinic open right now. I went there.

First there was a machine that seemed to want my card. I put my card in, and it didn’t look like any of the available possibilities fit. So I asked the creature sitting behind a desk operating a telephone what to do. She was just unpleasant and offensive. I finally discovered that there was another machine with different possibilities. This gave me a number which allowed me officially to talk the the creature with the telephone. I explained to her what the problem was; she talked to someone on the other end of the telephone, and they decided that my problem wasn’t urgent, so I should make an appointment or come back some other time.

That is the outcome.

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Thanks, everyone!

So far, so good. The abrasion seems to have healed completely. It was almost certainly related to serious wear and tear on my slippers. I have now inserted a new set of liners, and we’ll see how it goes.

Arrangements are now being made to get me the phone numbers, etc., of two more-or-less specialists in the diabetic foot - one is indeed a podiatrist, though not licensed in this country (someone I know uses his services), and one is a nurse who has been specializing in the diabetic foot for years. I hope I’ll be much better prepared for next time.

I’d still like information on mirrors with long, angled handles made for much purposes.

Thanks.
M.

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Try L. L. Bean’s Wicked Good slippers. I have worn them for years. They have arch support and lots of cushioning, so they work well with my diabetic feet!

Thanks.

In addition to waiting for the abrasion to heal, I put new padded liners in my old slippers. They’re Hush Puppies, by the way, and very good.

I also got the name of a podiatrist who is said to be good, not too far away, and alive. I would have to pay privately, though. But I guess that’s better than dying of gangrene, which is particularly unpleasant.

In case anyone needs the information, I have also had a very good experience a long time ago buying airy, spacious “climbing” shoes via WWW from Land’s End.

Thanks.
M.

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