the story of my foot

[Originally posted on Friday, September 16, 2022, at 3:18 a.m.]

The following is a scary and disgusting tale—not for the squeamish. You've been warned. 

Some weeks ago, I noticed a disturbing change happening in/on/around my right big toe. The usual callus was there, but much of it was black, and there was a small, unwontedly soft region that seemed to be filled with pus. No smell despite the blackened skin, so this wasn't gangrene—a thing we diabetics all fear because gangrene heralds the loss of an appendage. 

But what was it? I probed and prodded my foot several nights in a row, and eventually, I narrowed things down to two possibilities: (1) another toe infection, but with a bleed happening underneath the callus (hence the black color), or (2) a diabetic ulceration, which would also explain the pus. If this was the latter, then it was possible that gangrene was on its way. In either case, the treatment would require debridement and disinfection. 

Debridement refers to the removal of foreign matter and/or dead tissue from around a wound. I've removed toe callus with clippers before; I sometimes do a sloppy job of it, which occasionally leads to infections like the severe one that put me in the hospital early during the pandemic. There was, bizarrely, a hole in one part of the callus, like a cave for a very tiny troll—a good place to start clipping away. But before I started clipping, I somewhat unwisely began picking at that hole with my fingers, probably because it represented a weak point in the callus (and picking at it was psychologically gratifying). Eventually, the picking morphed into a full-on attack, by which I mean the debridement of all the thick, blackened skin and most of the surrounding callus as well. This wasn't pretty, as you'll see below.

The all-out assault meant relying on the various clippers in my mani-pedi kit, as well as a mess of disinfectant wipes, alcohol swabs, and first-aid ointment. I also had to lay out a tissue on which to deposit all the dead skin I was cutting off my toe. Nice. I eventually managed to cut away all the callus, exposing the fresh skin (smelly thanks to the blackened blood, but clean after some alcohol-swabbing) under which lay that deposit of pus. 

Out of morbid curiosity, I sterilized a dental probe (the kind with a sharp-pointed hook) and poked into the skin, hoping to lance the area and let the stinky pus run. But something strange happened: no pus came out, no matter how deeply I dug into the hole I'd made, and no matter how much I pushed on the sides of the pus zone. I shrugged, swabbed the poke-hole with alcohol, slathered on some antibiotic first-aid cream, and bandaged my foot. 

For several days after that, my routine became to wash, swab, apply cream, and re-bandage my foot. About two weeks later, I carefully checked the results of my efforts, and my foot seemed to be as good as new, except for a few stray black spots (see the final pic in this photo essay). That's a relief. I won't be losing my toe after all, but this feels a bit like a warning from Mother Nature. Losing parts of yourself is a nasty reality for diabetics who don't make an effort to reverse their diabetes (and by the way, the notion that diabetes is reversible is still not accepted by all doctors). Self-care, in all its forms, is paramount.

So, Dear Reader, steel yourself. Here are some pics, mostly of my initial efforts to remove all that callus, much of which had blackened. I'll leave you to imagine the smell of the exposed fresh skin underneath the callus and the congealed blood. The first four images were taken on August 23 as I was cutting most of the callus away. After August 23, I worked on my toe some more, debriding even more callus, until my big toe was relatively smooth. Somehow, maybe because I was being more cautious than usual, I managed to avoid bleeders this time. The fifth and final image is from September 9. This had been a long ordeal, but everything ended happily, so all the effort was worth it.

Last chance, now—these images might make you squirm. I have a clinical fascination with this sort of thing, and I'm weirdly proud of my... well, not quite self-surgery, but intense self-maintenance. I had thought I might need to visit a specialist, but it turned out that I was competent enough to take care of myself (with a little help from Google as to what to do). Next step: stitching wounds closed, Rambo-style.

OK... you've been warned. Brace for impact.

clipping away and lifting up some of the blackened callus

Above, you can start to see the pus-filled area peeking out from under the callus. Even before I removed the callus, I was able to palpate the area and feel the soft region that contained the pus. It's just so weird that no pus ever came out.

taking a closer peek (I was using my convex clippers to hack at the callus)

There was definitely a smell as I peeled away the blackened skin. I swabbed at every stinky area with my alcohol wipes and my regular disinfectant wipes, and you can bet I washed my feet thoroughly both before and after this procedure. You'd think the exposure of the fresh, tender skin would have been painful, especially with the alcohol-swabbing, but there really was no pain. (I suffer from some diabetic numbness, but not much.)

Here, I've succeeded in cutting away most of the surrounding callus.

There was a sickening moment during which I wondered whether bone might actually poke through. That's back when I was obsessed with the idea that this was a diabetic ulcer (I'm no longer convinced that that's what it was; a serious ulcer would probably have sunk deeper). At the same time, if this had been an infection, there should have been other symptoms like general redness, swelling, and fever (as happened in 2020). But this time around, there was no fever, and for the record, no pain as I was clipping away at the skin.

All in all, I thought this wasn't a bad job.

Before I show you the final photo, I'll note that the four pics above represent only the first stage of the debridement. You see all the other callus around that wound? I went back and took care of that, too, between August 23 and September 9, but I didn't bother to take any pictures. In the end, my big toe was about as callus-free as it's been in a long time. Once I finished my debridement, I continued washing, disinfecting, and bandaging the toe. None of this ever affected my ability to walk, so I continued distance walking as I healed, even though that meant the eventual return of some callusing. 

Below: and now, at last, my toe as of September 9—just a few days ago. The flecks of black can be clipped away if I so desire, but they're not significant: they don't run deep into the toe at all, so I'm not worried about them. I tentatively conclude that my self-care regimen took care of the problem. Whether this was an ulcer of some sort or an infection like the one from 2020, debridement, disinfection, and constant washing seemed to be the ticket to regaining my toe. I'm letting the toe build its usual callus back up again; that's probably a good thing for the upcoming month of walking on Jeju Island and along the Nakdong River.

And I really need to start using other pedicure tools like my nail file and those cheese-grater doohickeys to smooth out my callused skin. A now-healthy toe, about two weeks later:

I hope you weren't eating as you went through these photos. If you did make it through them, well, that's a real testament to your dedication to this blog. Next time I have a sucking chest wound, I'll be sure to document that as well.