Nasty Festering Blood Blisters

Nasty Festering Blood Blisters


(upbeat music) – Hey everybody, it’s
Dr. Freels again here. We are with a young lady
who is a Type 2 diabetic. Unfortunately, she has
undergone amputation of the toe. When was the last time
you saw a podiatrist? It’s okay, their not– – [Patient] More than six months ago. – More than six months ago. So, unfortunately we
are to the point where we’ve got some blood blisters, we’ve got a lot of callousing. So we’re going to get
everything cleaned up, we’re going to drain the blood blisters. She has fantastic circulation, so I’m not really concerned
about you healing the wound. Of course, being a diabetic, that you are immunocompromised, so we’ve got to watch these very closely. But we want to get all
of the drainage out, and then of course I told you
about the iodine, to use that. That’s how we’re going to treat the wound. So we’ll walk through it together, if you want to kind of take a peek. I just started trimming this callous here. It’s quite thick, you
can see this cap here was trimmed off first, and we’ve already discussed how we can prevent this in the future. One of the things that we’re going to do is a minimally-invasive surgical procedure that we do here, which is basically clipping
the toe underneath. If you want more information
about that, you can watch, that’s hard right there, you can watch our video
that we already have on YouTube and Facebook. It’s called a hammertoe release, or correction, or something. It’s a really good video
in a step by step process and how that is. So, as you can see, hers is reducible. These are little guys, this is like paring a rock. These are hard. And she can’t feel a thing, which is good. And sometimes when they’re this hard what we can do is put a
little saline on there and get the tissue nice
and soft if we need to, so there’s probably going to be some areas I might have to do that
to, but let me see. There we go. And you just wear a regular tennis shoe? – [Patient] Right. – [Dr. Freels] You know, often
when we do an amputation, we will do a toe fill, which
is basically an insert, and do this part, fill
this part of the toe. So the foot still feels that that part of the toe is there. Because what’s happening is
she’s getting these hammer toes because the toes around
it is compensating. Plus you have, we talked
about your higher arch. – [Patient] Oh my gosh. – [Dr. Freels] Wish you guys knew, this is really tough skin. (laughs) So it’s only been six months. So this tells me you
need to be seen monthly, to trim these callouses. But again, the goal of doing a procedure is to hopefully prevent
it from building up. And if you do get a slight buildup then it’s going to be not as severe. Do you have any questions for me while we’re kind of whittling away here? This is going to take a few minutes. No? Pretty good to go? (laughing) – [Patient] Yeah, I’m good. – [Dr. Freels] Okay. Yeah, there we go, looking much better. And you can see all
these little spots here, it’s actually dried blood from pressure. And so that’s how callouses form, the pressure and whatever area, if it’s on the bottom of your foot, if it’s on the tip of
your toe from hammertoes, creates bleeding underneath the skin. So a lot of people, when they see this, they’re like, “Is that
a wart? What is that?” That’s actually bleeding
from the pressure, so we know we really need to
get the pressure off of there. Okay, so trim over here on this toe. – [Assistant] I’ll just kind
of move this way, there we go. – [Dr. Freels] A good view? All right. Get all this off. Now you’re a Type 2 diabetic. – [Patient] Yes. – [Dr. Freels] You’re quite young. How did you end up being a
Type 2 at such a young age? – [Patient] Well, I had
extremely high triglycerides. They would be like 5600. – [Dr. Freels] Oh my God. – [Patient] So it got
to where I was having to be put in the hospital like twice a month with pancreatitis. – [Dr. Freels] Wow. And once I got the
pancreatitis the first time, then I become a diabetic. – [Dr. Freels] Gotcha. – [Patient] And last year,
I had weight loss surgery. – [Dr. Freels] You look great! – [Assistant] Do you want a handle? – [Dr. Freels] Huh? – [Assistant] Do you want a blade handle? – [Dr. Freels] I might
want a blade handle. I’m not going to lie, my hands are starting to
cramp up a little bit. Okay, we’re back. Got a nice blade handle. Take some pressure off
of the tip of my finger. We were just discussing, before we started filming I was checking her range of motion, and she actually has
something called equinus. Or, equine, like a horse. When I tell people,
especially in Kentucky, I’m like, “You walk like a horse.” Everyone gets it around here. You know, the point is, you’re putting too much pressure
to the ball of your foot. And, as you can see, these toes are just developing all
these callousing formations because of all the shift
of the weight there. This one’s actually going
to open up a little bit next to our little blood blister here. Right in there. The good news is, we’re catching
it before it’s too deep. And so we can get all this cleaned up, ’cause any of this dead
skin will break underneath. Once that skin breaks, you
get that hard callous overtop and then it ulcerates and then that’s when we run into problems. That ulcer will, let’s see here, this is just, it’s soft. The ulcer of course can get infected, and then the bone can get infected. – [Patient] And then you
wind up with half a toe. – [Dr. Freels] And then you
wind up with half a toe. (laughing) At least you’re in good spirits about it. I’m sure at the time it
was pretty traumatic. – [Patient] No, I ask. – [Dr. Freels] You did?
– [Patient] I had to ask and ask and ask and
couldn’t get anything done and I finally just asked
my primary care doctor, ’cause I happened to be in
the hospital at the time. And I was just like, “Can you see what’s “going on with my toe?” – [Dr. Freels] Right. – [Patient] And he took
me down for an x-ray and came back and told me what it was and I was just like,
“Take the whole thing.” – [Dr. Freels] Right.
She had an osteomyelitis, which is a bone infection. I’m really happy to report, everybody, that after taking this
blood blister, the cap off, that the skin underneath is very healthy. It looks good. Also, we already discussed
your good blood flow. So that’s so important to
heal something like this. I will tell any students or
residents that are watching, if you, or potential
patients, if you go to trim and do some own surgery
on your own at home, and you do not have blood flow, you are creating many, many more problems. You never want to do that, because you are making the wound bigger. You’re not helping it. So don’t get any blades out at home if you don’t have good blood flow. Look here, look at that skin. That’s good. Look at that, let’s just
get all the gunk off. Yeah, much better. Really, looking at this part right here. See that? Make sure that’s not getting
into the next layer of skin. And the toes are kind of hard to trim because they’re so small. You know, and you’ve got
to kind of take your time, whittle around it. You don’t want to make any big slices, even though this callous is golly, probably feel like an inch thick. (laughs) But I mean look at the tray here. Look at everything we’ve gotten so far. Okay, that looks good. Got this one little piece. I’m a perfectionist, so I want
everything to be just right. Okay, let’s look at the bottom here. I’m going to tilt you
up just a little bit. (table whirring) Save my back a little bit. You’ve got a little bit, not bad. I’m probably going to have you go back and grab me another blade before
we move onto the next foot. – [Assistant] Sure. – [Dr. Freels] So, we were discussing, before we started filming, that one of the big things we want to do, like I said, is stretch. Every day she’s going to
spend about 15 to 20 minutes, and we have a link on our website, for those of you at home that
want to start stretching, because we absolutely
have to get the pressure off of the ball of the foot. That’s why you see a lot of people that have ulcers in this
particular area here, this is underneath the big toe joint. All right, I’m going to let
you grab that blade for me. – [Assistant] Yep. – [Dr. Freels] I’ll
take the other foot now. All right. I don’t use these enough,
they’re kind of hard to get on. Okay, where do we want to start? Let’s start here. (laughs) So she’s going to be
using stretching splints, or a night splint, every day. Ideally, wear it as much as you can. Some people sleep in them. Others wear them whenever
they’re sitting down watching TV for a few hours, but the more you wear it, the better. What that’s going to do is
give you a constant stretch on the achilles tendon to help alleviate some of the pressure here. When I was doing a lot of
foot surgery for wound care when I was in Atlanta, we always did a release
of the achilles tendon to get the pressure off
of the ball of the foot. That’s how common it is to get pressure in these areas and also
have a tight heel core. So that’s essential in kind
of changing the mechanics of how the foot functions
to get the weight off of it. Okay, you don’t go barefoot do you? – [Patient] Mmm-mm. – [Dr. Freels] Okay, thank God. Okay, so not only are we going to do that to really kind of change her gait and get her more heel to toe, we are also going to do
a mold of her foot today to make a custom orthotic. And what I’m going to do
is offload these areas that are pressure points. Sorry Haylyn. – [Assistant] That’s okay. – [Dr. Freels] Get out of my way. (laughing) All right, we forgot we got
this callous over here too. So make sure, document that. I didn’t tell you about that one. – [Assistant] Okay. – [Dr. Freels] It was a surprise callous. Okay, so this is the
sub-fifth metatarsal head. So you kind of function as a tripod. You put a lot of pressure
and weight to your heel, of course, and then this head of the bone and then this head of the bone. So what I’m going to do
is just some rebalancing with your orthotics so you use all five metatarsal bones evenly. Well I’m definitely getting
my workout today here. (laughing) So if anybody has any questions about their family,
friends, or themselves, like, in regards to diabetes,
callousing, blood blisters, you name it, just drop a comment. This little guy’s hard to get to. And I’m happy to respond back. If you guys want to see any
videos, just let me know. We do this stuff all day long, so this is just kind of our normal day. But if you like it and
you want to see more, just let us know what you want to see. Also, don’t forget to
sign up for our channel so you get alerts every
time we get to whittle away or see something neat. We have a hookworm video. (laughs) Yeah. This patient had gone
to, oh gosh, what was it? St. Lucia or some island in the Caribbean and they had been playing a
lot of volleyball on the beach. And barefoot, of course. I mean, who goes to the
beach and wears shoes? And a hookworm had gotten in his foot. By the time I got him, it was bad. It was tunneling everywhere. So that’s a pretty neat
video for you guys to watch if you like this stuff. Also, we have another one with gout. That was just oozing all these crystals and it was pretty neat. It’s kind of actually
how this all got started. Okay. You can see, I don’t even know how much dead skin we’ve got down here. I’d probably make a good wood maker. (laughing) You have to go so slow
because you don’t want to slip and cut the toe next to it ’cause everything’s so close. We’re getting there though. So, like I said, you’re
going to put some betadine or iodine, whatever you’ve got at home. It’s available everywhere. And you’re going to paint it on the area where the blood blisters are and then cover it with some gauze. Every day, and then you’re
going to come back in two weeks so we can kind of take a peek to make sure everything’s healed. I think you’re going to be just fine, but you will please call
us with any concerns in the meantime. Just to let you know also, diabetics have first priority coming in. We have four providers here, someone can get you in
same day for any concerns, for signs of infection,
such as redness, drainage. What’s going on here? Here we go. Something, a little pressure. That just came out, didn’t it? There we go. Okay, so you’re getting
some, what appears to be, I don’t know if this is, almost looks like some purulent drainage, but there’s no odor. This is typically a sign of infection. Let’s get in here a little more. Whatever’s in there we
want it to come out, ’cause the last thing you want that to do is sit in there, – [Patient] Fluid? – [Dr. Freels] Continue to damage the skin underneath the blister. And yeah, this is just dead stuff. Let’s check out this a little more here. Okay, everything’s cleaning up. Looking good, looking good. Just a little old fluid. You’ve got a small wound
on the tip of this area, but not bad at all. This little top right here and I think we’re pretty much done. So let’s do some betadine here and then I want it here. Much better. All right, everybody, thanks for watching another episode of a two
drainage of blood blisters and I don’t even know how many callouses, I’ve completely lost count. Everything’s been cleaned
up and she is ready to go, we’re just going to get her wrapped up and get her out of here. Thanks for watching everybody,
I’ll see you next time.

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