A Piece of Shoe as a Foreign Body in a Patient with Type II Diabetes and Peripheral Neuropathy

Additional Authors

Beth Bulawa, Department of Surgery, Ballad Health, Greeneville, TN.

Abstract

There are approximately 38 million people in the United States who have diabetes. Half of diabetics have or will experience peripheral neuropathy (PN) predisposing them to foot injury with delays in diagnosis and care. Choice in proper footwear is crucial for this patient population. We present a 55-year-old male with a history of poorly-controlled diabetes and PN who presented to an urgent care after stepping on an unknown object that punctured the sole of his left foot. Initial X-ray revealed no abnormalities. The puncture site was sutured and antibiotics initiated. The next day, he presented to ED with swelling/erythema of the left dorsal foot reaching the mid-leg along with a 1.5cm wound to the plantar forefoot. Radiography revealed soft tissue gas in the dorsal foot without osseous abnormalities. Broad-spectrum antibiotics were started empirically, and the patient was admitted. General surgery was consulted who noted crepitus of the dorsal foot, prompting debridement in operating room (OR). The foot was opened widely on both surfaces which revealed a deep abscess through-and-through the foot between tendons on both surfaces. Additionally, 2 large pieces of mesh that appeared to be shoe were removed. The patient returned to the OR the next day for further debridement. The patient was discharged home on post-operative day (POD) #4, and he presented to outpatient wound care daily for dressing changes until he returned POD#13 for final debridement. At this time, the sole of the foot was closed, but a dorsal residual defect remained due to insufficient tissue coverage. This was treated with wet-to-dry dressing changes and followed until healed. Our case presents an unusual type of foreign body—the patient’s shoe. care. Careful consideration of proper footwear is encouraged for diabetic patients with PN. The patient was successfully treated with multiple debridements, delayed closure, and close follow up.

Start Time

16-4-2025 1:30 PM

End Time

16-4-2025 4:00 PM

Presentation Type

Poster

Presentation Category

Health

Student Type

Clinical Doctoral Student (e.g., medical student, pharmacy student)

Faculty Mentor

Lou Smith

Faculty Department

Surgery

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Apr 16th, 1:30 PM Apr 16th, 4:00 PM

A Piece of Shoe as a Foreign Body in a Patient with Type II Diabetes and Peripheral Neuropathy

There are approximately 38 million people in the United States who have diabetes. Half of diabetics have or will experience peripheral neuropathy (PN) predisposing them to foot injury with delays in diagnosis and care. Choice in proper footwear is crucial for this patient population. We present a 55-year-old male with a history of poorly-controlled diabetes and PN who presented to an urgent care after stepping on an unknown object that punctured the sole of his left foot. Initial X-ray revealed no abnormalities. The puncture site was sutured and antibiotics initiated. The next day, he presented to ED with swelling/erythema of the left dorsal foot reaching the mid-leg along with a 1.5cm wound to the plantar forefoot. Radiography revealed soft tissue gas in the dorsal foot without osseous abnormalities. Broad-spectrum antibiotics were started empirically, and the patient was admitted. General surgery was consulted who noted crepitus of the dorsal foot, prompting debridement in operating room (OR). The foot was opened widely on both surfaces which revealed a deep abscess through-and-through the foot between tendons on both surfaces. Additionally, 2 large pieces of mesh that appeared to be shoe were removed. The patient returned to the OR the next day for further debridement. The patient was discharged home on post-operative day (POD) #4, and he presented to outpatient wound care daily for dressing changes until he returned POD#13 for final debridement. At this time, the sole of the foot was closed, but a dorsal residual defect remained due to insufficient tissue coverage. This was treated with wet-to-dry dressing changes and followed until healed. Our case presents an unusual type of foreign body—the patient’s shoe. care. Careful consideration of proper footwear is encouraged for diabetic patients with PN. The patient was successfully treated with multiple debridements, delayed closure, and close follow up.