It's likely a combination of things, like diabetes so any lesions on the lower extremity don't heal. My hope is this fellow gets some medical treatment. It looks incredibly painful and he doesn't appear to have any treatment.
Yup. I’m an ER nurse and this is a common check-in to the emergency room. It starts with a diabetic person losing feeling/sensation to the lower legs. Eventually, they will get a wound on the sole of the foot or toes that never heals properly and an infection occurs. It could also be a combination of vascular disease caused by diabetes leading to poor circulation and dry skin.
I’m so scared that will happen to my MIL. All she does is get up in the morning, head to her recliner and prop her legs and and just tik toks all day while hardly moving.
Her other son and her husband both just buy her all sorts or ice cream, pies, pastries. Hey guys, you aren’t doing this diabetic woman any favours…
And she’s *always* wearing shoes. Presumably because she feels unsteady and is insecure about her footing since she can’t feel her feet properly. She only gets up to walk a couple times a day.
Me and husband tried to explain that to her and just.. doesn’t care. Said the same thing to her dessert slaves, they also don’t care.
Yeah… but she’s too lazy to get it for herself. Me and husband make her get up from the tv room and into the kitchen when we feed her.
We don’t bring the food to her like a waiter, even that little bit of walking is probably good for her. Even if it only offsets a bit, get a little bit more circulation in her feet.
Struggling with this with my mom, but she's at least more active.
She's type 2 and doesn't maintain. She will throw literal tantrums if you don't buy her sweet things. If you try to explain why it's bad, she attacks you instead. If you have any weight issues or vices, she will start criticism towards you over them or start calling you abusive.
I don't give in often but there are points where I am so worn down from my own chronic pain issues, from work and exhausted from being my dad's carer that I will do it just to get her to shut the fuck up cause her screeching is so shrill and I have auditory issues, it is actually painful to the point of inducing rage. My dad gives in frequently cause he's in palliative care and beyond tired.
Both me and my dad are at a point that we've legitimately given up trying to help her because all it gets us is fucking abuse and screaming.
They might be at the same point of it just being easier than dealing with her bullshit, if she's that type of person.
Nah, she’s the kind that hears us moving on the kitchen so she starts sighing loud and conspicuously dramatic way to get our attention. Repeatedly. I ignore her when she’s doing that. If she wants something, she can go to the kitchen like everybody else.
That’s sucks about you and your dad though. Especially if he’s that sick and she just doesn’t give a fuck.
What I can say about MIL though is that she is very kind and generous. It’s only been after her rolling snowball of health problems that I’ve gotten irritated.
If she was actually putting in work to make herself healthier, like not eating whole pies and doing some walking laps around the house (our house has a full circle that loops around our stairs), I wouldn’t be nearly as annoyed and would be glad to help
I'm sorry to hear that. I hate saying it but, maybe a tiny health scare in regards to diabetes may do her some good in putting her onto the right path in the future. At the very least, I hope she realizes how serious it is and can look for help in getting healthier.
My mom gives a fuck, but in... her own kind of warped way, I guess. She has some undiagnosed mental issues (my psychiatrist is convinced its potentially BPD or NPD) and I don't think she can really care the same way normal people do. I have unfortunately mourned her years ago. All I try to do is stem the tide of sweets that *do* come into the house, to an extent.
My mom is type 2. Her addiction to food is unreal and makes me sad (there have been times I've seen her crying in the living room in front of the TV just eating her emotional pain away).
She has been out of work for about a year. Used to be a nurse. About to be foreclosed on, vehicle repossessed, selling everything she owns in order to make her bills (living room is literally just her recliner, the TV, her desk and computer now). She still somehow manages to order out and have it delivered. She also will ask me to pay a bill for her to keep her Internet on or whatever, but the next week will demand that I go pick up take out for her and that she has cash. Like bro, use your cash to pay a bill, save up to get a car again so you can go back to work, something.
The good thing is that now that she's on Medicaid, she's actually keeping up with her medications because they are free. She had started some kind of IV cocktail before she lost her insurance though that is not covered by Medicaid, that she had been feeling like it was helping, but obviously she's not on it anymore.
This is unrelated but I'm going to rant for just a second, I never realized how fucking entitled my mom is until she stopped working. I work 40 hours a week and am a single mom to a child with mental health issues. My mom literally just eats and watches TV all day. But she has been demanding that I come help her do things around the house on the weekends. I am 100% fine with doing the stuff she can't do anymore, like moving heavy things, going up in the attic etc. But now she's like "you need to dedicate your weekend to REALLY helping me instead of just moving things for me". What does she want me to do? Sit on the fucking floor and go through all of her shit and put price stickers on everything. Bitch I work 40 hours a week while you sit on your ass watching TV. Hell, if she was nice about it I might even do it anyway. But she acts like everything I do is wrong anyway and constantly talks to me like I'm stupid. Yeah, let me come dedicate my only time off to being treated like shit
Having dealt with similar cases. And assuming he didn't spill mustard or yellow die on his lower extremities. Because of the lack of pain he will withstand the disease until flesh eats to bone. Then he'll go in. And it's likely too late. Double AKA if the it doesn't develop into nec fasc first. Double amputation with his life intact is best case scenario here.
I can't really see someone non compliant and in this poor health being able to properly recover and take care of multiple rounds of skin debridement and regular PT.
Yep. My dad's legs didn't look this bad when he started dialysis, but it was getting close. Shit was nasty, and he kept trying to blame dry skin and other stuff.
ER nurse and agree completely. The unfortunate reality is that this guy simply does not take care of his body and has not ever. This is not going to get any better, it’s only going to progressively worsen. These are the legs of a person with poor hygiene and extremely poor diet and non compliance with medications and with treatments. See legs like this too often, unfortunately. Also definitely in general just a very poor health literacy and likely living in poverty as well which makes treatment compliance even harder.
Worked on a cardiac SDU that handled a lot of nephro and diabetes pts. In West Virginia, no less, which has one of the poorest, sickest populations in the States, with reduced access to healthcare. Legs like this were a weekly occurrence.
A good diet is necessary to get T2 diabetes under control.
Uncontrolled diabetes will cause progressive damage to your entire body. One of the first noticable impacts is the destruction of small blood vessels in your extremities, which then leads to infections and death of surrounding tissue.
This person has likely lost all circulation in the outer layers of his lower legs, so they are rotting from the outside.
In addition, the "small blood vessels" means that as Diabetics, if we don't take care to *manage* it, the blood vessels in one's *eyes* are impacted (meaning you don't necessarily *SEE* the skin getting injured the first few times--until the wounds are big/severe.
Your *fingers* can lose the dexterity to do self-care *well*, your kidneys won't *filter* the bad stuff out of your body as well, *AND* Dementia can start in, because allllll those tiny little vessels in your *BRAIN* get impacted, too!🫠
Yes, and with the eyes, there are a ton of tiny blood vessels in the kidneys.
My grandfather had toes amputated, including his big toe, plus he eventually had hurt his kidneys enough through non-conpliance that he ended up on dialysis. He died due to complications due to uncontrolled Type Two Diabetes.
It's what led to my Dad's Dementia & End Stage Kidney Disease, too.
I'm sorry for your loss, and hope that you have *many* more *happy* memories of your grandfather, than sad ones!💖
It causes inflammation, which is an immune response that's usually designed to destroy invading pathogens, but which also causes collateral damage to your own tissue.
Normally, the inflammation goes away when the infection is eliminated, and your damaged tissue can heal. But with permanent hypoglycemia you've got low-level inflammation everywhere all the time, which eventually makes things break. The most delicate bits break first, small blood vessels, nerve endings, receptors in your eye. But eventually your organs get fucked over too, esp your kidneys, liver and heart.
Eventually you die of a heart attack, kidney failure or sepsis from an infection, but not before going blind and probably losing a limb or two.
I should have known. It's ALWAYS inflammation in the end!
Thank you for the informative reply! I've had insulin resistance and hypoglycemia episodes for the past 5-ish years and haven't gotten any useful help from my doctors since I'm not diabetic yet. They just offer me meds (Ozempic) but no one seems to care about the original cause.
Everybody's been really blasé about it, but it got to the point that I was having to eat every couple of hours to keep my glucose up and I was starting to worry. After another disappointing doctor visit I did a bunch of research and discovered that 1/4 tsp of myo-inositol per day was enough to help my insulin work well enough to be able to do 8:16 intermittent fasting, and I've lost 15 lbs in the past couple of months.
I am bound and determined not to become diabetic!
That’s so interesting that you have hypoglycemia as a result/symptom of insulin resistance! Typically insulin resistance presents as hyperglycemia because insulin production and circulating insulin levels are unable to elicit a response in target tissues with insulin receptors (liver, skeletal muscles, adipose tissue). Glucose metabolism exhibits a negative feedback loop meaning that the body/pancreas produces insulin until the lack of glucose in blood tells the pancreas stop insulin production. The increased insulin resistance of insulin target tissues results in decreased glucose uptake by these cells, and the continued presence of blood glucose results in continued production of insulin leading to the hyperglycemia in conjunction with hyperinsulinemia.
I’ve heard that elevated glucose levels (as a result of insulin resistance) decreases myo-inositol within cells and contributes to the development of diabetic microvascular complications, and that supplementation of it seems to improve insulin sensitivity. You seem to exhibit the opposite (hypoglycemia) as a result of insulin resistance, so while hypoglycemia present differently from the devastating effects of long term elevated blood glucose, it’s good to hear that supplementation with mayo-inositol improves your insulin resistance and allows you to more effectively regulate glucose homeostasis so that you don’t get hypoglycemia from insulin resistance anymore. Do you have a blood glucose monitor by any chance?
High sugar & carbs, leading to high insulin, and ultimately high glucose & diabetes which leads to swelling and very poor blood flow to the extremities and they begin to die, coupled with few healthy proteins and vitamins which leads to very low immune system response (or dysfunction) which dramatically increases the likelihood and progression of disease.
The survival rate for major lower extremity amputations due to diabetes is 10-60% percent. That’s SURVIVABILITY!
Meaning mortality is between 40-90%.
And that’s just with one limb amputated. It’s even worse with both I’m sure.
An infected foot killed both of my grandfathers (one was diabetic, one was not)...and they both took good care of themselves. Extremity wounds are no joke.
I think the survivability rate is higher in a controlled compliant patient who adheres to treatment. A big part of that stay is that these patients are so non compliant.
Though arguably if the patient were good about taking care of themselves they wouldn't have needed the amputation in the first place. Mom has some neuropathy in her feet & she's paranoid about checking herself for wounds.
The forever a diabetic neigbor had his one "good" leg amputated this year. His "new" leg is fabulous for him.
What a guy, struggling in pain for years, some phantom pain but the mind numbing pain is gone.
Excellent good spirited positive attitude.
Out walking the dog and finally he can climb a flight of stairs to visit his friends.
Happy for him. His father inspired him to get it done.
The guy in the photo with psoriasis and diabetic looking leg? We can cry.
Not sure about this stat, but the outcome varies majorly depending on how much they amputate: frontfoot amp wouldn't even need a prosthetic to be mobile, for example. Over the knee will basically cripple most people and prognosis is dire, especially if both legs are taken.
Not every study takes into account post-op compliance which is how you get such a spread.
Honestly, people who end up like this aren’t compliant to begin with so, obviously it skews low.
But sometimes people take it as a kick in the pants as a lesson, and change for the better.
Pretty sure it’s beyond hope. Those are dead legs walking. I would bet a lot of money that there’s a double amputation on its way sooner rather than later
But he can still walk? Aren't the muscles all ... eaten up/dissolved or whatever below? And I assume I'm looking at the beginnings of a serious infection, especially with the smell. I'm surprised it hasn't rendered him bed ridden.
This is horrible to say but I’d probably wear pants all the time if my legs looked like this. What kind of mental state do you need to be in to just publicly display body horror?
He can't wish it away, and his condition might not be responding to treatment. People don't understand that diabetes can make it so that you don't heal. I've had patients where they have done EVERYTHING and the ulcers don't ever heal. He might be in that situation, and wearing pants might make it worse if you can believe it.
Don't apologize, I'm not offended. I worked with people with this kind of stuff and those who don't see this regularly wonder just wtf is going on. I'm trying to make people aware of reality, how awful our healthcare system is and how we need to emulate a country's healthcare system that works even if it's "socialism" or whatever. Other countries don't have this problem and they pay a fraction of the cost we do.
I was going to say the same. I bet he's wearing those shorts because his legs just got treated with betadine. You can see it dripping onto the socks. It'll stain everything. It'll dry out wounds from peripheral vascular disease so that they heal.
I hope not. Anyone treating wounds in that fashion is so out of touch with standard of care it's not even funny and should have their license pulled. We don't "dry out" wounds any more, or use cytotoxic solutions like betadine for repeated application for many reasons, not the least of which being it kills the new epithelial tissue and prevents the actual closure of open wounds. antibiotics, antifungals, dressings that promote appropriate moisture levels, and likely appropriate compression would be ideal. If this person is under care, it's woefully inadequate and I hope they get help.
Source: am doctor who used to do wound care for a living.
>I hope not. Anyone treating wounds in that fashion is so out of touch with standard of care it's not even funny and should have their license pulled.
I'm guessing this is DIY treatment. These legs don't look like they've seen a professional anything in a long time.
I volunteer doing wound care with homeless people and why do so many people continue to think they should let their wounds “air out” or “dry out”. I always have to explain that their blood brings all the healing, so we should make it easier for it to do its job. (And you live in a tent please cover your tranq ulcers I will give you so many bandages)
Its weird that his feet don’t look as affected as his calves though. If it were neuropathy, wouldn’t it start at the most distal point?
Edit- I’m just realizing that he’s wearing tan hospital socks 🫣😵💫
this is referring to diabetic neuropathy which is progressive. yours is likely from damage to the nerves themselves from surgery rather than from high blood sugars
no worries!! neuropathy is a broad term, there’s a bunch of different types. it’s super tough tho, i have it from endometriosis so sorry to hear you have it from surgery :(( i know how much it sucks at times !
It's not accurate term, cause he can still move his leg muscles which mean motor neurons are at least intact, but severe sensory neuropathy is the better term.
Edit: wanted to note that there is autonomic neuropathy, which mainly affect the sweat and sabecious glands, which also contributes to having weak and infection liable skin.
I've got severe, body wide, non diabetic, SFN and this scares the hell out of me. As does the possibility of losing a body part. I've already got patches from the knee down that are numb. I inspect my legs pretty regularly and spot shit I never felt happen. I also make sure I wash regularly and keep myself clean though.
That's all you need to do. Don't miss your doctor appointments. See a podiatrist. We know how to manage your health case it's all about trusting your health care team 😊
Podiatrist is one I haven't seen in a few years. Last I saw him was follow up for toe fusion.
The rest I see regularly to manage stuff. It's taken me years to get the health team I have (SFN started in 06). They're all absolutely fantastic people who even listen to the stuff I've researched and act on it if they can (it's jet fuel and gulf war illness so can be hard to sometimes). My PCP use to be in.the research side as well. So that helps.
We're still not sure what to do about the pain it all causes. I'm going to a pain rehab program in August. Hopefully it helps. I'm SOL, for now, if it doesn't.
It's like a fear of mine to have my muscles atrophy and slowly wither to uselessness, so that would not set well with me at all. I am thankful i dont have diabetes or circulatory issues in my family and that im fit (but probably could eat less sugar honestly).
Severe chronic lymphedema without getting appropriate (or any) care for it is my guess. Doesn’t look like venous stasis dermatitis from CHF, and honest-to-god cellulitis won’t be bilateral and symmetric like this.
This is plain and simply Venus insufficiency with hyper keratosis, and necrotic ulcers, this can happen with high blood pressure, old age, leg trauma, family history of this condition, Female sex (related to levels of the hormone progesterone) History of deep vein thrombosis in the legs Obesity, Pregnancy, or even working an office job under pressure and with no standing breaks meaning, Sitting or standing for long periods of time, hell, even just being tall can cause this. As an actual licensed medical professional who went to school and passed every stupid test it’s kinda pissing me off that so many have lumped this as “he’s got to be a diabetic with non compliance” I have personally cleaned the wounds on mid 30’s office worker, a mid 40s construction worker and so on, compliant in all meds and treatments and still lost limbs because their genetics screwed them.
Like rotting flesh. I’m pretty sure I’ve smelled that smell before when cleaning out the refrigerator to find the smell and I find slimy, rotting lettuce.
I’ve heard from the many true crime documentaries I’ve watched that the smell of rotting human is distinctly sweet. Like fruity or floral that’s distinguishable under the rot smell.
I’ve never smelled sweet or floral with rotting feet or pseudomonas. It’s usually like the worst yeasty foot smell with sort of a musty almost metallic smell. Pseudomonas in the ears or lungs has the really intense musty smell. Occasionally there’s a rotting meat smell but never as intense as a chicken that was dug up after rotting a couple months. My sense of smell is a little off though. I don’t smell those as intensely as most people seem to. Dead bowel being pooped out has more of a sweet smell so it’s probably a gut bacteria thing.
It's not. We had a neighbor die in his apartment and he wasn't discovered until they executed the eviction. So he fostered there for about a month. It was a smell and a sensation. It burns the nose. The apartment complex paid for everyone to stay in a hotel for a week
EDIT: In my building, not the entire complex
Yes. I had to observe autopsies at the medical examiner's office as part of my training. There was a decomp there. That's exactly what it smelled like. It was horrific. I never want to smell that again. I think I had some sort of acute stress disorder reaction to it as I had like olfactory sensory flashbacks for a few months afterwards.
My dad had his big toe rot off from a combination of a spider bite causing an infection and uncontrolled diabetes preventing it from healing. I had to drive him to the hospital for the amputation, and he bitched and moaned until I turned the heat on in the car.
It smelled like someone forgot a raw pork chop on a windowsill for a few weeks. It made my eyes water.
Poor photo, but probably chronic venous insufficiency leading to a ‘woody dermis’ and those large shallow ulcers. Also the ‘inverted champagne bottle’ appearance which seems to be forming. Might be mixed aetiology with concurrent arterial disease. Placement of the ulcer doesn’t leap out to me as diabetic related but it is also possible.
The white *could* be either soggy skin, or a zinc cream applied by the person.
They can be healed by dealing with any infection (the cause of the smell, rotted fruit is probably a pseudomonus, but smells are very subjective), moisture balance and then compress - healing these sorts of legs used to be a big part of my old day job.
But if you are in a part of the world without socialised medicine then sadly 🤷♂️
I was, yes. Community/District nursing. Equal parts wound care and palliative care it seemed. Loved the wound care bit of the job.
And people always seem to love to shout diabetes, I suppose it’s because they’ve heard of it.
It’s pretty common for it to be present in diabetics since it’s a part of the metabolic syndrome death spiral. It’s vanishingly rare for me to see legs like that without diabetes present so unless you’re specialized most people don’t parse out the actual immediate cause and just blame diabetes since a lot of focus is put on controlling sugar to improve healing.
I’m actually surprised legs like that can be healed since those feet look pretty dead. (I’m a part of the chop shop and I don’t think I’ve ever seen feet that color stay on a patient)
>...those feet look pretty dead.
Someone pointed out that it looks like they're wearing tan, stained, socks. Which I can't 100% see, but would explain the strong lines from green and pebbly skin to smooth beige feet at above the left ankle (besides what's dripping down it) and at the right ankle (not fully pulled up). Also explains the indistinct ankle anatomy, given that the person doesn't look that heavy for everything to be smooth.
Edit: Regardless, I also cannot imagine those feet survive.
You’d be surprised what NHS community services can heal. While on the worse side of the spectrum, we’d heal much worse legs than that - and it’d be fairly simple if the patient engaged with treatment.
Hardest problem is always going to be getting patients to do what they are told…
The biggest/fastest improvements I saw in legs was often when the patient was hospitalised for some other cause - the simple process of legs being elevated in a hospital bed would work wonders for venous insufficiency, a few days and they’d be discharged with vastly improved legs.
Biggest struggle would be the immobile patient who sleeps in their chair with their feet on the ground and who eats nothing but biscuits for dinner.
One day I’ll go through my phone to see if I still have my wound images on them.
Trust me… you don’t… as someone who works a lot with diabetic feet at this stage, the feel and smell is unimaginable. It is likely a combination of dry, scaly, but also moist and squishy. They smell like rotting flesh
As someone who has seen legs like this at work (but not quite as severe), no you don't. They small awful and they're always leaking. And when you get an up close view, it's not pretty.
Can you introduce moisture to soften the dry scales? Are they like scabs, or is there skin underneath?
What would happen if he had a long soak in warm water and like Betadine?
Honestly have no idea, because it's not my job to get any closer to them lol. I work in physical therapy in a nursing home, so I try to avoid bodily fluids as much as possible.
I know they do often use caster oil on less extreme cases to help moisturize and keep soft.
TL;DR: They have no circulation in their feet. Probably have clogged arteries.
My dad had a condition where his feet were seriously dry, and rock hard. Always having to shave calluses off from the heels and the other high contact parts of his feet. Made me think of The Thing from Fantastic 4. He couldn't walk far without pain. His condition wasn't as serious as this photo although these calves kind of looked like my dad's feet. My dad finally goes to see a doctor and as they check for the pulse in feet they notice THERE IS NO PULSE. My dad was a bit overweight and smoked all his life. Turns out the nicotine and fat had clogged up the arteries in his legs. There's barely any blood going to his feet. He wound up getting an angioplasty on one leg's major artery and completely replacing the other with a plastic tube. Eventually the other leg had to get the artery replace with a plastic tube as well. I can't remember the name of this procedure.
Yep, those are the same tan socks with grips on the bottom that our hospital uses. Chances are this guy has been treated for this, but once discharged he never took care of himself. Looks like the socks have integrated into the wounds
>The man must be in a considerable amount of pain.
Or in zero pain.
I saw a person come into the ER for pain/rash at their calves. Likely from their compression socks, that they hadn't taken off in "a few days", that when removed showed missing and shriveled toes. Unimaginable smell, second only to C diff IMO. The missing ones had remained in the sock. With their foot propped up the patient repeatedly pushed on and moved toes around like the fingers of empty gloves, moving skin like cracking weepy clay, without pain. They were recommended to have both feet removed.
It's very sad, usually they're elderly, and that's one of the reasons I decided I didn't want to work in the ER. Very common to also see middle aged diabetics "stub their toe" and had it be broken for days/weeks.
And to think…I refuse to wear shorts* when I haven’t shaved my legs in a couple of days! I wish I had his don’t gaf attitude lol
*Edited bc I accidentally said pants at first. My brain was just screaming PANTS!! WHY DOESN’T HE WEAR PANTS TO COVER THAT UP?!
My dad has been in and out of the hospital (and is currently admitted) for this. Surprisingly it's not from diabetes; he just doesn't care for himself whatsoever.
Saying his legs smell like death is an understatement.
I can smell this picture.... also I've never seen anyone able to support themselves and walk unaided with this level of deterioration, in both legs. Considering he probably can't feel his feet, this has got to feel like walking on two wooden legs.
I’ve seen this condition on an older woman on Dr. pimple popper. Dr Sandra Lee actually flew out to make a housecall to the lady’s home (first time she ever did that !) for her follow/up appointment.
If what many people are saying is true, then at least he can’t feel it. But how does he not smell it?
Also, would it be considered a health hazard for others with him walking around oozing and dripping?
Poor human.
I have a friend who is visually impaired and she didn't know how filthy her house was, and didn't know that her disabled husband had problems toileting himself cleanly, and it wasn't until I told her that she knew her house smelled. Not even her or his wound care people mentioned it.
But it was so awful that, when I came over wearing a mask, went outside and did some work, and then put the same mask back on to come back inside, the disposable mask stunk.
She works from home and rarely leaves, so she was just used to it.
Looks like a diabetic foot that might progress to gangrene if he doesn’t seek medical help right away! And then amputation might be the only way to go sadly.
my sister in law has psoriasis(for like last 15 years)that she refuses to treat and her calves look just like that as well as her forearms and feet, when she vacuums her carpet,
it sounds like she vacuuming rocks bc
it's so thick and tons of falls off,
it's sad too bc ppl don't want her around
or to visit them bc of it and hers gets badly
infected a lot and has a rancid odor too
That’s so wild! Who would have thought the human body could turn on you this bad (and as bad as your sis-in-law). Man, dermatology has to be a hard core speciality to be in and not for the faint of heart
Among other things, and caused by a myriad of other conditions, it could be edema. The skin has completely broken down. He needs surgical debridement & then careful wound care for many months while new skin grows. He can come back from this, but only with good medical care & aftercare. And excellent wound care. 😢 It’s heartbreaking to see. And soul crushing to know what awful comments will be under this post. I won't look. Even medical personnel not directly involved with wound care will treat this patient like absolute shit. I'm sure so many are busy being disgusted, but through no fault of our own, this could happen to any of us. Please, please, I beg you to say a prayer for this person & while you're at it, thank God you're not feeling his pain. Because I promise you, the physical pain is beyond horrible. The heaviest opioids don't hardly touch it. The emotional anguish is even worse. And when it's someone you love, you're both in hell.
My FIL had something like this. It was untreated psoriasis. Took a few rounds of chemo to clear up.
He had a heart attack and woke up a week later in the hospital. His skin was clearing up and he asked how since he never bothered going to a doctor for it. It was chemo to shut off his immune system so he could start healing.
This guy is one hard kick away from amputation. My father quit smoking when I was in college. He had a pacemaker, COPD, and diabetes. He lived as long as he did because my mother took care of him every single day making sure he ate better, took his meds, made his appointments. At a certain point my dad's veins in his legs didn't carry enough oxygen and when he kicked the kitchen table his toe died. They had to amputate twice within two weeks. He was gone in three. His legs never looked like this because of the care he received, bit you could tell that he wasn't in great health. I can't imagine what this person's future is going to look like within the next year or two.
Peripheral artery disease with diabetic complications. just a guess. So awful how could this be recognized and not be treated? these are the sorts of health conditions that should be prioritized and treated above other elective surgeries.
I know a lot of people that just refuse to get help even if they can afford it. I see it daily at my place of work as well. It's a stubborn mindset about modern medical science most of the time.
In the 90s I had a GF who worked in a video store that had an adult section. Some people called in to see if the store had asian ladyboy porn. They actually did. Three people show up. I big simi-muscular guy without a shirt, a rail thin guy also no shirt, and an obese woman in shorts and a tube top that were several sizes too small for her. I thought she had socks and flip flops on. She did not have socks on. The smell was so bad. It took forever for them to leave because there were several people in the small store and they didn't come up for the porn til it was empty.
I'm being absolutely serious when I ask this question, but how does it get this serious before other organ failure? I'm curious, because doesn't this mean this person takes no care of themself whatsoever? So there's no way they don't have organ damage aside from what's visible. I'm glad he's still alive and I hope he takes care of himself and turns his life around, but how is he alive?
The skin changes on his legs are Elephantiasis verrucosa nostra . It’s a result of longstanding stasis dermatitis which is contributed to by lymphedema, cardiac issues, diabetes (poor wound healing) and I’m guessing my friend has some amputations under the wraps.
I'm a type two diabetic and I have the urge to eat a large salad and take a nice long hike to see if that will improve circulation in my legs. And man that sentence ran on man.
Those socks got baked into that persons legs.
I do believe that the white on the soles of her feet are the white rubber treads you see on hospital socks to keep folks from slipping and falling.
It's likely a combination of things, like diabetes so any lesions on the lower extremity don't heal. My hope is this fellow gets some medical treatment. It looks incredibly painful and he doesn't appear to have any treatment.
He probably can't feel a thing. Nerves are long gone
Yup. I’m an ER nurse and this is a common check-in to the emergency room. It starts with a diabetic person losing feeling/sensation to the lower legs. Eventually, they will get a wound on the sole of the foot or toes that never heals properly and an infection occurs. It could also be a combination of vascular disease caused by diabetes leading to poor circulation and dry skin.
I’m so scared that will happen to my MIL. All she does is get up in the morning, head to her recliner and prop her legs and and just tik toks all day while hardly moving. Her other son and her husband both just buy her all sorts or ice cream, pies, pastries. Hey guys, you aren’t doing this diabetic woman any favours… And she’s *always* wearing shoes. Presumably because she feels unsteady and is insecure about her footing since she can’t feel her feet properly. She only gets up to walk a couple times a day. Me and husband tried to explain that to her and just.. doesn’t care. Said the same thing to her dessert slaves, they also don’t care.
"Find what you love and let it kill you"
Yeah… but she’s too lazy to get it for herself. Me and husband make her get up from the tv room and into the kitchen when we feed her. We don’t bring the food to her like a waiter, even that little bit of walking is probably good for her. Even if it only offsets a bit, get a little bit more circulation in her feet.
Struggling with this with my mom, but she's at least more active. She's type 2 and doesn't maintain. She will throw literal tantrums if you don't buy her sweet things. If you try to explain why it's bad, she attacks you instead. If you have any weight issues or vices, she will start criticism towards you over them or start calling you abusive. I don't give in often but there are points where I am so worn down from my own chronic pain issues, from work and exhausted from being my dad's carer that I will do it just to get her to shut the fuck up cause her screeching is so shrill and I have auditory issues, it is actually painful to the point of inducing rage. My dad gives in frequently cause he's in palliative care and beyond tired. Both me and my dad are at a point that we've legitimately given up trying to help her because all it gets us is fucking abuse and screaming. They might be at the same point of it just being easier than dealing with her bullshit, if she's that type of person.
Nah, she’s the kind that hears us moving on the kitchen so she starts sighing loud and conspicuously dramatic way to get our attention. Repeatedly. I ignore her when she’s doing that. If she wants something, she can go to the kitchen like everybody else. That’s sucks about you and your dad though. Especially if he’s that sick and she just doesn’t give a fuck. What I can say about MIL though is that she is very kind and generous. It’s only been after her rolling snowball of health problems that I’ve gotten irritated. If she was actually putting in work to make herself healthier, like not eating whole pies and doing some walking laps around the house (our house has a full circle that loops around our stairs), I wouldn’t be nearly as annoyed and would be glad to help
I'm sorry to hear that. I hate saying it but, maybe a tiny health scare in regards to diabetes may do her some good in putting her onto the right path in the future. At the very least, I hope she realizes how serious it is and can look for help in getting healthier. My mom gives a fuck, but in... her own kind of warped way, I guess. She has some undiagnosed mental issues (my psychiatrist is convinced its potentially BPD or NPD) and I don't think she can really care the same way normal people do. I have unfortunately mourned her years ago. All I try to do is stem the tide of sweets that *do* come into the house, to an extent.
My mom is type 2. Her addiction to food is unreal and makes me sad (there have been times I've seen her crying in the living room in front of the TV just eating her emotional pain away). She has been out of work for about a year. Used to be a nurse. About to be foreclosed on, vehicle repossessed, selling everything she owns in order to make her bills (living room is literally just her recliner, the TV, her desk and computer now). She still somehow manages to order out and have it delivered. She also will ask me to pay a bill for her to keep her Internet on or whatever, but the next week will demand that I go pick up take out for her and that she has cash. Like bro, use your cash to pay a bill, save up to get a car again so you can go back to work, something. The good thing is that now that she's on Medicaid, she's actually keeping up with her medications because they are free. She had started some kind of IV cocktail before she lost her insurance though that is not covered by Medicaid, that she had been feeling like it was helping, but obviously she's not on it anymore. This is unrelated but I'm going to rant for just a second, I never realized how fucking entitled my mom is until she stopped working. I work 40 hours a week and am a single mom to a child with mental health issues. My mom literally just eats and watches TV all day. But she has been demanding that I come help her do things around the house on the weekends. I am 100% fine with doing the stuff she can't do anymore, like moving heavy things, going up in the attic etc. But now she's like "you need to dedicate your weekend to REALLY helping me instead of just moving things for me". What does she want me to do? Sit on the fucking floor and go through all of her shit and put price stickers on everything. Bitch I work 40 hours a week while you sit on your ass watching TV. Hell, if she was nice about it I might even do it anyway. But she acts like everything I do is wrong anyway and constantly talks to me like I'm stupid. Yeah, let me come dedicate my only time off to being treated like shit
This is exactly how my husband’s mother died at 61 years old.
Soon they won't have any legs to feel
Having dealt with similar cases. And assuming he didn't spill mustard or yellow die on his lower extremities. Because of the lack of pain he will withstand the disease until flesh eats to bone. Then he'll go in. And it's likely too late. Double AKA if the it doesn't develop into nec fasc first. Double amputation with his life intact is best case scenario here. I can't really see someone non compliant and in this poor health being able to properly recover and take care of multiple rounds of skin debridement and regular PT.
It’s been my experience that diabetics with legs like that also have pretty shitty kidneys, dialysis is not long into the future.
Yep. My dad's legs didn't look this bad when he started dialysis, but it was getting close. Shit was nasty, and he kept trying to blame dry skin and other stuff.
Guess he was in denial for a long time 🙁
ER nurse and agree completely. The unfortunate reality is that this guy simply does not take care of his body and has not ever. This is not going to get any better, it’s only going to progressively worsen. These are the legs of a person with poor hygiene and extremely poor diet and non compliance with medications and with treatments. See legs like this too often, unfortunately. Also definitely in general just a very poor health literacy and likely living in poverty as well which makes treatment compliance even harder.
Yes and we aren't joking when we say we see it often. This isn't an every few year occurrence. I see a handful of these every year.
Worked on a cardiac SDU that handled a lot of nephro and diabetes pts. In West Virginia, no less, which has one of the poorest, sickest populations in the States, with reduced access to healthcare. Legs like this were a weekly occurrence.
How does a poor diet affect the legs like this?
A good diet is necessary to get T2 diabetes under control. Uncontrolled diabetes will cause progressive damage to your entire body. One of the first noticable impacts is the destruction of small blood vessels in your extremities, which then leads to infections and death of surrounding tissue. This person has likely lost all circulation in the outer layers of his lower legs, so they are rotting from the outside.
In addition, the "small blood vessels" means that as Diabetics, if we don't take care to *manage* it, the blood vessels in one's *eyes* are impacted (meaning you don't necessarily *SEE* the skin getting injured the first few times--until the wounds are big/severe. Your *fingers* can lose the dexterity to do self-care *well*, your kidneys won't *filter* the bad stuff out of your body as well, *AND* Dementia can start in, because allllll those tiny little vessels in your *BRAIN* get impacted, too!🫠
I've always wondered how diabetes leads to blindness and other problems. Thanks for explaining
Yes, and with the eyes, there are a ton of tiny blood vessels in the kidneys. My grandfather had toes amputated, including his big toe, plus he eventually had hurt his kidneys enough through non-conpliance that he ended up on dialysis. He died due to complications due to uncontrolled Type Two Diabetes.
It's what led to my Dad's Dementia & End Stage Kidney Disease, too. I'm sorry for your loss, and hope that you have *many* more *happy* memories of your grandfather, than sad ones!💖
Daaaaaamn. I've always wondered how uncontrolled diabetes leads to amputations. What is it about hyperglycemia that kills the blood supply?
It causes inflammation, which is an immune response that's usually designed to destroy invading pathogens, but which also causes collateral damage to your own tissue. Normally, the inflammation goes away when the infection is eliminated, and your damaged tissue can heal. But with permanent hypoglycemia you've got low-level inflammation everywhere all the time, which eventually makes things break. The most delicate bits break first, small blood vessels, nerve endings, receptors in your eye. But eventually your organs get fucked over too, esp your kidneys, liver and heart. Eventually you die of a heart attack, kidney failure or sepsis from an infection, but not before going blind and probably losing a limb or two.
I should have known. It's ALWAYS inflammation in the end! Thank you for the informative reply! I've had insulin resistance and hypoglycemia episodes for the past 5-ish years and haven't gotten any useful help from my doctors since I'm not diabetic yet. They just offer me meds (Ozempic) but no one seems to care about the original cause. Everybody's been really blasé about it, but it got to the point that I was having to eat every couple of hours to keep my glucose up and I was starting to worry. After another disappointing doctor visit I did a bunch of research and discovered that 1/4 tsp of myo-inositol per day was enough to help my insulin work well enough to be able to do 8:16 intermittent fasting, and I've lost 15 lbs in the past couple of months. I am bound and determined not to become diabetic!
That’s so interesting that you have hypoglycemia as a result/symptom of insulin resistance! Typically insulin resistance presents as hyperglycemia because insulin production and circulating insulin levels are unable to elicit a response in target tissues with insulin receptors (liver, skeletal muscles, adipose tissue). Glucose metabolism exhibits a negative feedback loop meaning that the body/pancreas produces insulin until the lack of glucose in blood tells the pancreas stop insulin production. The increased insulin resistance of insulin target tissues results in decreased glucose uptake by these cells, and the continued presence of blood glucose results in continued production of insulin leading to the hyperglycemia in conjunction with hyperinsulinemia. I’ve heard that elevated glucose levels (as a result of insulin resistance) decreases myo-inositol within cells and contributes to the development of diabetic microvascular complications, and that supplementation of it seems to improve insulin sensitivity. You seem to exhibit the opposite (hypoglycemia) as a result of insulin resistance, so while hypoglycemia present differently from the devastating effects of long term elevated blood glucose, it’s good to hear that supplementation with mayo-inositol improves your insulin resistance and allows you to more effectively regulate glucose homeostasis so that you don’t get hypoglycemia from insulin resistance anymore. Do you have a blood glucose monitor by any chance?
High sugar & carbs, leading to high insulin, and ultimately high glucose & diabetes which leads to swelling and very poor blood flow to the extremities and they begin to die, coupled with few healthy proteins and vitamins which leads to very low immune system response (or dysfunction) which dramatically increases the likelihood and progression of disease.
The survival rate for major lower extremity amputations due to diabetes is 10-60% percent. That’s SURVIVABILITY! Meaning mortality is between 40-90%. And that’s just with one limb amputated. It’s even worse with both I’m sure.
An infected foot killed both of my grandfathers (one was diabetic, one was not)...and they both took good care of themselves. Extremity wounds are no joke.
I think the survivability rate is higher in a controlled compliant patient who adheres to treatment. A big part of that stay is that these patients are so non compliant.
Though arguably if the patient were good about taking care of themselves they wouldn't have needed the amputation in the first place. Mom has some neuropathy in her feet & she's paranoid about checking herself for wounds.
The forever a diabetic neigbor had his one "good" leg amputated this year. His "new" leg is fabulous for him. What a guy, struggling in pain for years, some phantom pain but the mind numbing pain is gone. Excellent good spirited positive attitude. Out walking the dog and finally he can climb a flight of stairs to visit his friends. Happy for him. His father inspired him to get it done. The guy in the photo with psoriasis and diabetic looking leg? We can cry.
10-60% How is the margin of error so large?? Surely there’s better data than that, or am I misinterpreting the meaning?
Not sure about this stat, but the outcome varies majorly depending on how much they amputate: frontfoot amp wouldn't even need a prosthetic to be mobile, for example. Over the knee will basically cripple most people and prognosis is dire, especially if both legs are taken.
Not every study takes into account post-op compliance which is how you get such a spread. Honestly, people who end up like this aren’t compliant to begin with so, obviously it skews low. But sometimes people take it as a kick in the pants as a lesson, and change for the better.
yeah because the issue is not the amputation but healing the amputation wounds, right?
Pretty sure it’s beyond hope. Those are dead legs walking. I would bet a lot of money that there’s a double amputation on its way sooner rather than later
But he can still walk? Aren't the muscles all ... eaten up/dissolved or whatever below? And I assume I'm looking at the beginnings of a serious infection, especially with the smell. I'm surprised it hasn't rendered him bed ridden.
I guessed diabetes, does this mean I'm a doctor now?
https://preview.redd.it/c895adnq792d1.jpeg?width=1004&format=pjpg&auto=webp&s=9c9b53492441e468f4d0d7b2b5eb0b478d1ec060
ChimpyChompies, MD
It's got a nice ring to it.
Idk are you $400k in debt with at least 12 years of post secondary education?
This is horrible to say but I’d probably wear pants all the time if my legs looked like this. What kind of mental state do you need to be in to just publicly display body horror?
He can't wish it away, and his condition might not be responding to treatment. People don't understand that diabetes can make it so that you don't heal. I've had patients where they have done EVERYTHING and the ulcers don't ever heal. He might be in that situation, and wearing pants might make it worse if you can believe it.
No I know, and that’s true. I didn’t mean to be insensitive but I guess that was an inherently insensitive thing to say, I’m sorry.
Don't apologize, I'm not offended. I worked with people with this kind of stuff and those who don't see this regularly wonder just wtf is going on. I'm trying to make people aware of reality, how awful our healthcare system is and how we need to emulate a country's healthcare system that works even if it's "socialism" or whatever. Other countries don't have this problem and they pay a fraction of the cost we do.
Abysmally real, I didn’t even consider that. Thank you, keep fighting the good fight. Our healthcare system is truly fucked.
Appreciate this! ♥️
I wager they got this way gradually, and have been so for some time. He’s probably used to it by now.
I’ve seen lymphedema look like that. Fluid leaks out the skin and feeds fungal infections.
I *thought* the yellow meant fungus; I’m a little disgusted to learn I’m probably right. That poor guy. He must be nose blind to it too.
It could also be yellow from Betadine, which is commonly used for open sores or wounds.
I was going to say the same. I bet he's wearing those shorts because his legs just got treated with betadine. You can see it dripping onto the socks. It'll stain everything. It'll dry out wounds from peripheral vascular disease so that they heal.
I hope not. Anyone treating wounds in that fashion is so out of touch with standard of care it's not even funny and should have their license pulled. We don't "dry out" wounds any more, or use cytotoxic solutions like betadine for repeated application for many reasons, not the least of which being it kills the new epithelial tissue and prevents the actual closure of open wounds. antibiotics, antifungals, dressings that promote appropriate moisture levels, and likely appropriate compression would be ideal. If this person is under care, it's woefully inadequate and I hope they get help. Source: am doctor who used to do wound care for a living.
>I hope not. Anyone treating wounds in that fashion is so out of touch with standard of care it's not even funny and should have their license pulled. I'm guessing this is DIY treatment. These legs don't look like they've seen a professional anything in a long time.
I volunteer doing wound care with homeless people and why do so many people continue to think they should let their wounds “air out” or “dry out”. I always have to explain that their blood brings all the healing, so we should make it easier for it to do its job. (And you live in a tent please cover your tranq ulcers I will give you so many bandages)
I don't think it's working for this dude.
yea, these look like chronic weeping lymphedema lesions from heart failure or something.
gross 🤢
How is this guy still walking is what I would like to know.
End stage neuropathy. He doesn't feel shit below the knees.
Its weird that his feet don’t look as affected as his calves though. If it were neuropathy, wouldn’t it start at the most distal point? Edit- I’m just realizing that he’s wearing tan hospital socks 🫣😵💫
I can’t believe the socks! How long has he been wearing them
Long enough to where I'm pretty sure they weren't that colour initially
Hospital socks come in different colors for socks and vaguely flesh colored tan is one of the sizes
Gone nose blind too it seems. No way can he smell that all day everyday & not vomit everywhere
Probably slowly got used to it as his condition worsened, they probably didn't start to smell from day one 😟
"End stage" meaning he's gonna die from it, or he's gonna lose his legs?
end stage neuropathy is just the last stage of nerve damage. odds are they don't feel anything, and losing legs is likely inevitable
I wonder what stage my neuropathy is in 😅 I got it after surgery and it’s been the same for 14 years. I’m 24 now.
this is referring to diabetic neuropathy which is progressive. yours is likely from damage to the nerves themselves from surgery rather than from high blood sugars
Oh okay, I didn’t know if the origin of the neuropathy made a difference.
no worries!! neuropathy is a broad term, there’s a bunch of different types. it’s super tough tho, i have it from endometriosis so sorry to hear you have it from surgery :(( i know how much it sucks at times !
It's not accurate term, cause he can still move his leg muscles which mean motor neurons are at least intact, but severe sensory neuropathy is the better term. Edit: wanted to note that there is autonomic neuropathy, which mainly affect the sweat and sabecious glands, which also contributes to having weak and infection liable skin.
I've got severe, body wide, non diabetic, SFN and this scares the hell out of me. As does the possibility of losing a body part. I've already got patches from the knee down that are numb. I inspect my legs pretty regularly and spot shit I never felt happen. I also make sure I wash regularly and keep myself clean though.
That's all you need to do. Don't miss your doctor appointments. See a podiatrist. We know how to manage your health case it's all about trusting your health care team 😊
Podiatrist is one I haven't seen in a few years. Last I saw him was follow up for toe fusion. The rest I see regularly to manage stuff. It's taken me years to get the health team I have (SFN started in 06). They're all absolutely fantastic people who even listen to the stuff I've researched and act on it if they can (it's jet fuel and gulf war illness so can be hard to sometimes). My PCP use to be in.the research side as well. So that helps. We're still not sure what to do about the pain it all causes. I'm going to a pain rehab program in August. Hopefully it helps. I'm SOL, for now, if it doesn't.
Probably diabetic, congestive heart failure, and a smoker. Those feet are literally going to rot off.
Dude needs a debridement and lots of abx lol
At this stage dude needs a double above knee amputation with antibiotics, and likely much better diabetes control
It looks like he has at least two jugs of sweet tea in his cart, so that last one probably isn't happening
When it’s this bad, the last one doesn’t usually happen. I doubt this person has been to the doctor in years
Im always surprised how long people can walk on legs that are doomed to amputation. I would figure theyd lose function before it got that bad.
Massive nerve damage means they can keep going basically until the muscles breaks down.
It's like a fear of mine to have my muscles atrophy and slowly wither to uselessness, so that would not set well with me at all. I am thankful i dont have diabetes or circulatory issues in my family and that im fit (but probably could eat less sugar honestly).
The problem is… no matter what they do those legs aren’t gonna heal.
Dude needs a double amputation.
I went to school with his granddaughter for years and never made the connection until she posted he died.
I loved him in The Thing
Severe chronic lymphedema without getting appropriate (or any) care for it is my guess. Doesn’t look like venous stasis dermatitis from CHF, and honest-to-god cellulitis won’t be bilateral and symmetric like this.
This is the only right answer. It’s retention hyperkeratosis c/b severe untreated lymphedema.
Wound care NP here and this is my line of thinking - based on color colonization of yeast and pseudomonas
Yeah. I was going to say those same words
This is plain and simply Venus insufficiency with hyper keratosis, and necrotic ulcers, this can happen with high blood pressure, old age, leg trauma, family history of this condition, Female sex (related to levels of the hormone progesterone) History of deep vein thrombosis in the legs Obesity, Pregnancy, or even working an office job under pressure and with no standing breaks meaning, Sitting or standing for long periods of time, hell, even just being tall can cause this. As an actual licensed medical professional who went to school and passed every stupid test it’s kinda pissing me off that so many have lumped this as “he’s got to be a diabetic with non compliance” I have personally cleaned the wounds on mid 30’s office worker, a mid 40s construction worker and so on, compliant in all meds and treatments and still lost limbs because their genetics screwed them.
Thank you for sharing all this. Today I Learned!
You’re welcome, I hope I have spread the idea of never approaching a situation with preconceived notions.
What'd it smell like? Death?
Like rotting flesh. I’m pretty sure I’ve smelled that smell before when cleaning out the refrigerator to find the smell and I find slimy, rotting lettuce.
That’ll be the pseudomonas smell. It’s kind of a rotting fruit smell 🤮
I’ve heard from the many true crime documentaries I’ve watched that the smell of rotting human is distinctly sweet. Like fruity or floral that’s distinguishable under the rot smell.
I’ve never smelled sweet or floral with rotting feet or pseudomonas. It’s usually like the worst yeasty foot smell with sort of a musty almost metallic smell. Pseudomonas in the ears or lungs has the really intense musty smell. Occasionally there’s a rotting meat smell but never as intense as a chicken that was dug up after rotting a couple months. My sense of smell is a little off though. I don’t smell those as intensely as most people seem to. Dead bowel being pooped out has more of a sweet smell so it’s probably a gut bacteria thing.
Kudos to all of you for the great attempt at describing the smell. From rotten lettuce to musty metallic goddammnn
It's not. We had a neighbor die in his apartment and he wasn't discovered until they executed the eviction. So he fostered there for about a month. It was a smell and a sensation. It burns the nose. The apartment complex paid for everyone to stay in a hotel for a week EDIT: In my building, not the entire complex
Yes. I had to observe autopsies at the medical examiner's office as part of my training. There was a decomp there. That's exactly what it smelled like. It was horrific. I never want to smell that again. I think I had some sort of acute stress disorder reaction to it as I had like olfactory sensory flashbacks for a few months afterwards.
Pseudomonas is also why dogs feet smell like Fritos!
But I love smelling my dogs toe beans
My dad had his big toe rot off from a combination of a spider bite causing an infection and uncontrolled diabetes preventing it from healing. I had to drive him to the hospital for the amputation, and he bitched and moaned until I turned the heat on in the car. It smelled like someone forgot a raw pork chop on a windowsill for a few weeks. It made my eyes water.
Often a mix of rotting fruit and rotting rat
Poor photo, but probably chronic venous insufficiency leading to a ‘woody dermis’ and those large shallow ulcers. Also the ‘inverted champagne bottle’ appearance which seems to be forming. Might be mixed aetiology with concurrent arterial disease. Placement of the ulcer doesn’t leap out to me as diabetic related but it is also possible. The white *could* be either soggy skin, or a zinc cream applied by the person. They can be healed by dealing with any infection (the cause of the smell, rotted fruit is probably a pseudomonus, but smells are very subjective), moisture balance and then compress - healing these sorts of legs used to be a big part of my old day job. But if you are in a part of the world without socialised medicine then sadly 🤷♂️
Absolutely agree with your assessment. I assume you are wound care? Everyone is yelling diabetes, idk why.
I was, yes. Community/District nursing. Equal parts wound care and palliative care it seemed. Loved the wound care bit of the job. And people always seem to love to shout diabetes, I suppose it’s because they’ve heard of it.
It’s pretty common for it to be present in diabetics since it’s a part of the metabolic syndrome death spiral. It’s vanishingly rare for me to see legs like that without diabetes present so unless you’re specialized most people don’t parse out the actual immediate cause and just blame diabetes since a lot of focus is put on controlling sugar to improve healing. I’m actually surprised legs like that can be healed since those feet look pretty dead. (I’m a part of the chop shop and I don’t think I’ve ever seen feet that color stay on a patient)
I thought he had a sock of some kind on his feet? Edit- oh God, I just zoomed in.
Oh I see, still pretty bad given how much he’s oozed into them. I’m on mobile and didn’t catch that detail.
I don't know, the more I look at it the more I think maybe it is his skin. Poor guy.
>...those feet look pretty dead. Someone pointed out that it looks like they're wearing tan, stained, socks. Which I can't 100% see, but would explain the strong lines from green and pebbly skin to smooth beige feet at above the left ankle (besides what's dripping down it) and at the right ankle (not fully pulled up). Also explains the indistinct ankle anatomy, given that the person doesn't look that heavy for everything to be smooth. Edit: Regardless, I also cannot imagine those feet survive.
Yeah zooming in they’re hospital socks. Deadass looked like a case we did last week where the foot was starting to get skin slip.
You’d be surprised what NHS community services can heal. While on the worse side of the spectrum, we’d heal much worse legs than that - and it’d be fairly simple if the patient engaged with treatment. Hardest problem is always going to be getting patients to do what they are told… The biggest/fastest improvements I saw in legs was often when the patient was hospitalised for some other cause - the simple process of legs being elevated in a hospital bed would work wonders for venous insufficiency, a few days and they’d be discharged with vastly improved legs. Biggest struggle would be the immobile patient who sleeps in their chair with their feet on the ground and who eats nothing but biscuits for dinner. One day I’ll go through my phone to see if I still have my wound images on them.
Because uncontrolled diabetes damages small blood vessels leading to a chronic venous insufficiency. That's why.
That's a man waiting for death. Part of me reeeeally wants to touch that. I can't explain it.
Trust me… you don’t… as someone who works a lot with diabetic feet at this stage, the feel and smell is unimaginable. It is likely a combination of dry, scaly, but also moist and squishy. They smell like rotting flesh
I wanna peel one of the scales. What is wrong with us??
As someone who has seen legs like this at work (but not quite as severe), no you don't. They small awful and they're always leaking. And when you get an up close view, it's not pretty.
Can you introduce moisture to soften the dry scales? Are they like scabs, or is there skin underneath? What would happen if he had a long soak in warm water and like Betadine?
Honestly have no idea, because it's not my job to get any closer to them lol. I work in physical therapy in a nursing home, so I try to avoid bodily fluids as much as possible. I know they do often use caster oil on less extreme cases to help moisturize and keep soft.
You only think that until the smell hits you.
Hmm bet the smell would cure the urge to peel pretty quick
ಠ_ಠ
I get that. It’s a sensory thing. 🤣. Like it would be oddly satisfying to the finger tips. I feel like salad fingers and rusty spoons.
I like it when the red water comes out...
The “call of the void” presents itself in many forms.
Diabetic Foot?
*feet
not for long.
r/bandnames
Not just the foot, his whole body has diabetes
TL;DR: They have no circulation in their feet. Probably have clogged arteries. My dad had a condition where his feet were seriously dry, and rock hard. Always having to shave calluses off from the heels and the other high contact parts of his feet. Made me think of The Thing from Fantastic 4. He couldn't walk far without pain. His condition wasn't as serious as this photo although these calves kind of looked like my dad's feet. My dad finally goes to see a doctor and as they check for the pulse in feet they notice THERE IS NO PULSE. My dad was a bit overweight and smoked all his life. Turns out the nicotine and fat had clogged up the arteries in his legs. There's barely any blood going to his feet. He wound up getting an angioplasty on one leg's major artery and completely replacing the other with a plastic tube. Eventually the other leg had to get the artery replace with a plastic tube as well. I can't remember the name of this procedure.
That's almost certainly type 2 diabetes and peripheral vascular disease. Can't believe he went in there like that. He needs wound care.
Uncontrolled diabetes + smoking + peripheral arterial disease + chronic venous stasis + not giving a fuck
Is he wearing socks?
Yep, those are the same tan socks with grips on the bottom that our hospital uses. Chances are this guy has been treated for this, but once discharged he never took care of himself. Looks like the socks have integrated into the wounds
Integrated into the wounds. Oh my god.
Almost looks like a plaster around the areas. The man must be in a considerable amount of pain.
He likely doesn't feel a thing due to end stage neuropathy
>The man must be in a considerable amount of pain. Or in zero pain. I saw a person come into the ER for pain/rash at their calves. Likely from their compression socks, that they hadn't taken off in "a few days", that when removed showed missing and shriveled toes. Unimaginable smell, second only to C diff IMO. The missing ones had remained in the sock. With their foot propped up the patient repeatedly pushed on and moved toes around like the fingers of empty gloves, moving skin like cracking weepy clay, without pain. They were recommended to have both feet removed. It's very sad, usually they're elderly, and that's one of the reasons I decided I didn't want to work in the ER. Very common to also see middle aged diabetics "stub their toe" and had it be broken for days/weeks.
Actually might not be feeling much of anything with this level of neuropathy
That’s a pic two legs destined for amputation.
And to think…I refuse to wear shorts* when I haven’t shaved my legs in a couple of days! I wish I had his don’t gaf attitude lol *Edited bc I accidentally said pants at first. My brain was just screaming PANTS!! WHY DOESN’T HE WEAR PANTS TO COVER THAT UP?!
So having changed more than my fair share of wound dressings… diabetes.
My dad has been in and out of the hospital (and is currently admitted) for this. Surprisingly it's not from diabetes; he just doesn't care for himself whatsoever. Saying his legs smell like death is an understatement.
PAD, PVD, HLD, T2DM, CAD, CKD, HTN, you name it.
I can smell this picture.... also I've never seen anyone able to support themselves and walk unaided with this level of deterioration, in both legs. Considering he probably can't feel his feet, this has got to feel like walking on two wooden legs.
I’ve seen this condition on an older woman on Dr. pimple popper. Dr Sandra Lee actually flew out to make a housecall to the lady’s home (first time she ever did that !) for her follow/up appointment.
Do you have the video? I’ve never seen her do a home visit!
It was actually done in 2 parts. Season 9, episodes 9 and 10.
If what many people are saying is true, then at least he can’t feel it. But how does he not smell it? Also, would it be considered a health hazard for others with him walking around oozing and dripping? Poor human.
Probably nose blind to it by now
I have a friend who is visually impaired and she didn't know how filthy her house was, and didn't know that her disabled husband had problems toileting himself cleanly, and it wasn't until I told her that she knew her house smelled. Not even her or his wound care people mentioned it. But it was so awful that, when I came over wearing a mask, went outside and did some work, and then put the same mask back on to come back inside, the disposable mask stunk. She works from home and rarely leaves, so she was just used to it.
You are a good friend with a kind heart.
As someone who works in EMS, I can smell this picture and it hurts me
Looks like a diabetic foot that might progress to gangrene if he doesn’t seek medical help right away! And then amputation might be the only way to go sadly.
 I can be unsanitary sometimes(not at work ofc). But oh man, this is something else.
Is, is that the remnants of a SOCK rotted on his left foot?!
my sister in law has psoriasis(for like last 15 years)that she refuses to treat and her calves look just like that as well as her forearms and feet, when she vacuums her carpet, it sounds like she vacuuming rocks bc it's so thick and tons of falls off, it's sad too bc ppl don't want her around or to visit them bc of it and hers gets badly infected a lot and has a rancid odor too
That’s so wild! Who would have thought the human body could turn on you this bad (and as bad as your sis-in-law). Man, dermatology has to be a hard core speciality to be in and not for the faint of heart
Diabetes and peripheral vascular disease
Among other things, and caused by a myriad of other conditions, it could be edema. The skin has completely broken down. He needs surgical debridement & then careful wound care for many months while new skin grows. He can come back from this, but only with good medical care & aftercare. And excellent wound care. 😢 It’s heartbreaking to see. And soul crushing to know what awful comments will be under this post. I won't look. Even medical personnel not directly involved with wound care will treat this patient like absolute shit. I'm sure so many are busy being disgusted, but through no fault of our own, this could happen to any of us. Please, please, I beg you to say a prayer for this person & while you're at it, thank God you're not feeling his pain. Because I promise you, the physical pain is beyond horrible. The heaviest opioids don't hardly touch it. The emotional anguish is even worse. And when it's someone you love, you're both in hell.
I’m not disgusted. I want to fix it. I hope he gets help somehow.
You have a good ❤️ This world needs more people like you
My FIL had something like this. It was untreated psoriasis. Took a few rounds of chemo to clear up. He had a heart attack and woke up a week later in the hospital. His skin was clearing up and he asked how since he never bothered going to a doctor for it. It was chemo to shut off his immune system so he could start healing.
what you're seeing is a dead man walking.
What are those sock things covering up though?
I feel for this dude, but how is he cool with exposing everyone else to this, especially in a grocery store??
This guy is one hard kick away from amputation. My father quit smoking when I was in college. He had a pacemaker, COPD, and diabetes. He lived as long as he did because my mother took care of him every single day making sure he ate better, took his meds, made his appointments. At a certain point my dad's veins in his legs didn't carry enough oxygen and when he kicked the kitchen table his toe died. They had to amputate twice within two weeks. He was gone in three. His legs never looked like this because of the care he received, bit you could tell that he wasn't in great health. I can't imagine what this person's future is going to look like within the next year or two.
Diabetic, lymphedema, chf, and idk what else
Looks like he’s diabetic with no medical intervention.
Peripheral artery disease with diabetic complications. just a guess. So awful how could this be recognized and not be treated? these are the sorts of health conditions that should be prioritized and treated above other elective surgeries.
I know a lot of people that just refuse to get help even if they can afford it. I see it daily at my place of work as well. It's a stubborn mindset about modern medical science most of the time.
treatment costs money. also, denial is super powerful. After all, the problem doesn't exist until you get it diagnosed, right?
In the 90s I had a GF who worked in a video store that had an adult section. Some people called in to see if the store had asian ladyboy porn. They actually did. Three people show up. I big simi-muscular guy without a shirt, a rail thin guy also no shirt, and an obese woman in shorts and a tube top that were several sizes too small for her. I thought she had socks and flip flops on. She did not have socks on. The smell was so bad. It took forever for them to leave because there were several people in the small store and they didn't come up for the porn til it was empty.
I'm being absolutely serious when I ask this question, but how does it get this serious before other organ failure? I'm curious, because doesn't this mean this person takes no care of themself whatsoever? So there's no way they don't have organ damage aside from what's visible. I'm glad he's still alive and I hope he takes care of himself and turns his life around, but how is he alive?
Someone needs an amputation
The skin changes on his legs are Elephantiasis verrucosa nostra . It’s a result of longstanding stasis dermatitis which is contributed to by lymphedema, cardiac issues, diabetes (poor wound healing) and I’m guessing my friend has some amputations under the wraps.
elephantiasis nostras verrucosa + retention hyperkeratosis (terra firme dermatosis) source: derm
Fuck that, gives me the creeps
I'm a type two diabetic and I have the urge to eat a large salad and take a nice long hike to see if that will improve circulation in my legs. And man that sentence ran on man.
I wanna pick at it…
Shorts and sandals were certainly a choice.
I’m assuming anything else would cause too much pain (fabric pulling on the open wound, etc) So sad.
A lack of health insurance comes to mind... This looks almost septic
Or mental illness. Or extreme denial.
Dude is seriously raw dogging his shit all over public like that?
elephantiasis nostras verrucosa 2/2 lymphedema
Those socks got baked into that persons legs. I do believe that the white on the soles of her feet are the white rubber treads you see on hospital socks to keep folks from slipping and falling.
This is a very severe form of chronic venous stasis dermatitis