Houston Methodist. Leading Medicine

Foot FAQ

Question:

Sometimes I just don't get the medical world. I took my mother in to the local clinic at the strip mall downtown. I thought she was having a heart attack. They seemed much more concerned about a sore on her big toe. She ended up with a bill for several thousand dollars for a foot infection. Go figure! And they never even checked her out for a heart problem. What do you make of all that? Am I way off base in my thinking here?

Answer:

Anytime someone comes to a clinic or hospital, vital signs are taken as a routine first-step in the evaluation and diagnostic process. Questions are asked about history and current signs and symptoms. From this information, the health care professionals make a mental list of possible problems. Further testing proceeds in order to make the final differential diagnosis (in other words, figuring out which one of the possible problems is the actual problem). It is likely that in the first five minutes they were able to assess your mother and determine that she wasn't having a heart attack. The symptoms and history are classic but they would rely on more than that -- always taking measures to keep the patient safe and ensuring the best results. If it turns out she had a sore on the big toe, the next concern is for foot infection. And there may have been something in the history to tip them off to look for such a thing. Diabetes is the first condition that comes to mind as a potential cause of a sore on the toe in an older adult. Loss of sensation in the feet is the number one cause of foot amputations among patients with diabetes. Stubbing a toe or cutting the skin can go unnoticed in the absence of pain. Infection in an area with decreased circulation can go untreated for too long ending up in loss of toes, foot, and even the leg. In fact, two-thirds of all nontraumatic leg amputations are done on patients with diabetes. The potential seriousness of such a condition may be why they spent so much time and attention on the sore toe. But perhaps your mother doesn't have diabetes. Although diabetes is the number one cause of foot infections, such infections are also associated with other systemic conditions such as chronic kidney or liver disease, gout, and peripheral vascular disease. Anyone whose immune system isn't responding well (we say they are immunocompromised) for any reason are also at increased risk for foot sores leading to infections. The immunocompromised include the elderly, anyone taking immunosuppressant medications for rheumatoid arthritis or organ transplantation, AIDS patients, cancer patients, and anyone who is malnourished (alcoholics, people with eating disorders or chronic diseases). This may not answer your question directly but what we hope to do is give you a bigger picture perspective so you can better assess your mother's situation. Of course, this is all done in hindsight (after the fact). But spending a couple thousand dollars in diagnostic prevention may have saved your mother tens of thousands of dollars and loss of limb down the road. Oke A. Anakwenze, MD, et al. Foot and Ankle Infections: Diagnosis and Management. In Journal of the American Academy of Orthopaedic Surgeons. November 2012. Vol. 20. No. 11. Pp. 684-693.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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