case_images: PMC10788112_01
case_images: Photograph at initial examination. An ulcer is observed on the lateral side of the left heel. The SPP around the ulcer is low at 46 (A) and 16 (B) mmHg, respectively. (b) Photograph at admission. The ulcer is 3 cm in diameter and reaches the calcaneus
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case_images: PMC10788112_01_wjps-12-106-g001.jpg
case_images: F1
case_images: Tochigi, Japan with an ulcer on the outer side of his left heel (Fig. 1a). He had a history of toe amputation for foot gangrene and bilateral diabetic retinal detachment. The patient underwent debridement and conservative treatment with an ointment; however, the ulcer gradually worsened. The SPP around the ulcer was also low (Fig. 1a). The ulcer was 3 cm in diameter and deep enough to reach the calcaneal bone (Fig. 1b), with surrounding pain, redness, and heat sensations. However, the grafted skin did not take well and was partially necrotic (Fig. 1c). About two weeks after the start of rheocarna treatment, CRP tested negative, ulcer epithelialization was observed, and redness, heat sensation, and pain in the lower extremities improved (Fig. 1d). CTA and SPP improved markedly (Fig. 1d, 2b), and MRI showed no exacerbation of the osteomyelitis (Fig. 3b). Chronological change of CRP after admission is shown in Fig.1e.
case_images: (a) Computed tomography angiography before Rheocarna treatment showing severe calcification and stenosis of the left below-knee arteries. (b) Computed tomography angiography after Rheocarna treatment showing improved blood flow
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case_images: PMC10788112_01_wjps-12-106-g002.jpg
case_images: F2
case_images: Computed tomographic angiography (CTA) revealed severe calcification and stenosis of the left below-knee arteries (Fig. 2a). CTA and SPP improved markedly (Fig. 1d, 2b), and MRI showed no exacerbation of the osteomyelitis (Fig. 3b). Chronological change of CRP after admission is shown in Fig.1e.
case_images: (a) MRI STIR before Rheocarna treatment shows osteomyelitis progressing to the distal end of the tibia and cuboid bone. (b) MRI STIR after Rheocarna treatment shows no exacerbation of osteomyelitis
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case_images: PMC10788112_01_wjps-12-106-g003.jpg
case_images: F3
case_images: MRI showed osteomyelitis had progressed to the distal end of the tibia and cuboid bone (Fig. 3a), and wound healing and inflammation control were difficult.