RE: Gangrene Complication
From: Richard Rettig, DPM
This 23 year old Vietnamese male presented with an unusual condition. He had cardiac surgery in Vietnam in 2007 for tetralogy of Fallot. He said that following the surgery, "they gave me medicine that was too strong."
.jpg) |
Gangrene Complication |
He developed gangrene of the distal portion of all 10 toes. Since then, the distal tips of the toes have self-amputated except for the left hallux. The toenail is still growing from the matrix, and it appears that the uncut toenail is the only thing connecting the petrified portion of the toe to his body. I am not sure why he presented, since he refused permission to attempt to remove the remainder!
Richard Rettig, DPM, Philadelphia, PA, rich.rettig@verizon.net
RE: Pain in Dorsal Foot After IV insertion (Steven Lemberger, DPM)
From: Multiple Respondents
Differential diagnosis: Intermediate or medial dorsal cutaneous nerve injury or even deep peroneal injury, CRPS/RSD. Order EMG although nerves are too small. Start weeekly regional block (ankle/deep Peroneal/Superficial peroneal nerve), physical therapy without immobilization (if you suspect RSD/CRPS). Unfortunately, a Marcaine pump which we use on some of our patients post-operatively may cause more trauma. Bone scan may show early RSD.
Ido Friedman, DPM, Savannah, GA, habibi@pol.net
They may have nerve injury -- consider a superficial dorsal block.
Roody Samimi, DPM, San Diego, CA, roody.samimi@gmail.com
It sounds like your patient may have an iatrogenic A-V malformation. Those can be extremely painful. I would suggest a collaboration with your vascular colleague for a study and/or intervention. Also, consider nerve injury in your differential.
Svetlana Malinsky, DPM, College Park, MD, drmalinsky@yahoo.com
I would want to rule out neurolgic injury, including but not limited to a CRPS1/RSD.
Angelo J. Bigelli, DPM, North Providence, RI toedocri@aol.com
