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Case 74: Black toe

A 72 year old diabetic man presents complaining of pain in his foot.

1. What does the photo show?

Gangrene of the first and second toes that is long standing and well demarcated. It is largely dry and stable however there are some moist areas at the base of the second toe. The remaining foot has dystrophic skin and nails indicative of chronic ischaemia.

2. What are the principles of management?

Control of sepsis, investigation and management of underlying occlusive arterial disease, cardiovascular risk factor modification and wound management.

3. How would you manage these toes?

Swabs should be taken for microbiologic examination and broad spectrum intravenous antibiotics commenced. The toes should be allowed to dry and this may be facilitated by betadine gauze dressing which applied slightly moist and allowed to air dry. The foot should not be wrapped. A single piece of gauze should be placed between all the toes to separate them and allow the web spaces to dry.





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