Case 11: Purple Toes, ASO and Thrombocytosis



Purple Toes, Dusky Foot and Big Toe Ulcer on Presentation

This 82 year old lady with primary thrombocytosis had been treated with Myleran on two past occasions by her hematologist. She was referred for boot therapy with five painful left toes, a necrotic ulcer of the big toe, mottling of the plantar surface of the left foot and lesser but similar changes in the right foot. Her baseline brachial blood pressure was 214/105 when systolic pressures at the ankle were 128 in the anterior tibial, 114 in the posterior tibial and 134 in the peroneal arteries. Her popliteal and pedal pulses were not palpable in either leg. Her hematologist elected not to treat her platelet count of 912,000 which remained stable throughout her leg treatments. Her systemic medications included methyldopa 125 mg twice daily, dipyridamole 50mg three times daily, and propranolol 10 mg twice daily.

She was treated in the Miniboot with her left foot initially immersed in multielectrolyte solution (Sea Soaks-TM) containing gentamicin 80mg per half gallon (1.89 liters). When her ulcer healed, the antibiotic solution was omitted. Her feet did well. After her hospitalization, she noted occasional discoloration of a toe and sought boot treatment in the office successfully resolving the problem.




Ambulatory and Happy

Comments: She had arteriosclerosis obliterans and a platelet abnormality promoting small vessel occlusions. Both responded nicely over a few weeks time to boot therapy alone. Her care was orchestrated by her hematologist and the boot service. Another similar patient was under the care of her primary physician who consulted multiple physicians, gained multiple opinions and allowed us a few days of boot therapy before attempting bypass surgery. This second lady lost her leg.



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