SUMMARY: A 22 year old male suffered severe frostbite and cold injury to his feet. This injury resulted in toe amputation and major post traumatic Neurovascular Dystrophy in his feet and lower legs. This case history focuses on the long term treatment and retrogression of the man over the next 28 years.
|
1997 photo shows all 5 toes amputated. Surgeon was successful in retaining 1st
joint and bone of grand toe which has assisted R.M. in balance. Note red and purple
skin color development in right foot while standing without
Jobst
vascular support. |
HISTORY: While working night shift as a hotel desk clerk in January 1974,
R.M., a 22 year old man, was abducted and beaten by two assailants.
He was taken to a wilderness area and pushed out of a car into a snow storm
at approximately 1:00 A.M. at night. R.M. was not wearing shoes or winter clothing.
As he ran away into the darkness, his right sock caught on a shrub, leaving his right
foot bare. He remained outside, exposed to the cold (approximately 10 degrees
Fahrenheit) for about the next four hours. R.M. suffered hypothermia and severe
frostbite to both hands and both feet. His right foot was most severely affected and
later developed dry gangrene. All the toes on the right foot were later amputated.
R.M. almost died from exposure and injury. In the hospital, after life stabilization,
both hands and feet swelled greatly with second and third degree "burn type" injuries.
Huge white and black blisters developed. Treatment was focused on controlling the
development of wet gangrene and infection, particularly at the toes and waiting for
"demarcation" (the separation of living tissue from dead tissue).
During this resulting three month wait, he experienced extreme
burning stinging pain in his hands and feet that the treating physicians called
causalgia.
Causalgia, derived from the Greek (kausis, heat +
algos, pain), is defined as intense burning pain. The term is
considered by modern physicians to be antiquated and generally replaced by more
technically precise names of disorders including, Reflex Sympathetic Dystrophy
Syndrome and Neurovascular Dystrophy Syndrome.
 |
1997 photo shows close up view of top middle of foot and front of ankle.
Note advanced red and purple skin color development in right foot after standing without
Jobst
vascular support for several minutes. Scars and shiny skin are where 3rd degree "burn type"
injury and blisters occurred after 1974 frostbite injury. |
R.M. noticed that if a hand or foot was lowered below his torso
(dangled off the edge of the hospital bed) that the causalgia increased to an
intolerable level. The blood would flow down the extremity (enhanced by gravity),
but would fail to return (flow back up) normally. The doctors indicated that this
was due to vascular and sympathetic nervous system injury. After three months,
four of his five right foot toes were amputated due to infection and demarcation
(the 5th toe was amputated about a year later due to deterioration). The stinging
burning pain continued. After several years, the doctors decided that a right side
sympathectomy may control the causalgia. The sympathetic ganglia nerve chain in his
right lower torso was removed. He found that this controlled the burning pain by
about 40% but it still persisted to a disappointing level. Right side custom made
high compression
Jobst
pressure gradient anklet
vascular supports with enclosed front were prescribed and they again produced some
relief but the pain disorder still persisted.
 |
1997 photo shows R.M. reclining with
Jobst
vascular support in place. He must wear support at
all times, even while showering and swimming, to relieve burning stinging pain. He removes support
at bedtime. |
JOBST VASCULAR SUPPORTS CONTACT INFORMATION:
Jobst Institute, Inc.
Phone: (419) 698-1611
Jobst vascular supports are available by doctor prescription only.
TREATING PHYSICIANS' DIAGNOSIS:
Lower legs and ankles have permanent vascular and nerve damage due to frostbite
injury resulting in aching and burning pain.
Chronic Pain Syndrome in feet, lower legs.
Pain Syndrome is complicated by severe and persistent low back, shoulders, upper arms
and neck pain and Fibromyalgia,
but these disorders are mentioned in this case history only to explain
the "whole person" Chronic Pain Syndrome and are not points of focus here.
The Pain Syndrome causes poor quality sleep and resulting general fatigue.
R.M. currently has four additional disorders that contribute to his
chronic pain syndrome other than the Advanced
Neurovascular Dystrophy (RSD) of the feet and lower legs:
HOSPITALIZATIONS RELATING TO THE INJURY:
HOSPITALIZATION NOT DIRECTLY RELATED TO THE INJURY:
Box 653
Toledo, Ohio, U.S.A.
43697-0653
FAX: (419) 693-2162
Reorders: (800) 537-1063
http://www.jobst.com/
Severe frostbite to both feet resulting in all toes amputated on right foot and
permanent vascular and nerve damage to both feet. Neurovascular Dystrophy Syndrome,
(a.k.a. Reflex Sympathetic Dystrophy Syndrome, RSDS or Causalgia). Disethesia
throughout feet and lower legs.
Neuroma at amputation site. Excessive and abnormal foot perspiration due to
Autonomic Nervous System damage. Abnormal excessive development of corns and
callus on right foot due to abnormal distribution of body weight onto metatarsal
heads and remaining stump of great toe.
PHYSICIANS' LONG TERM TREATMENT HISTORY:
FEET: Right side sympathectomy surgery. High compression right anklet
Jobst custom
made pressure gradient vascular support with special closed front at amputation site.
Chemical or mechanical abrasive to control corns and calluses. Hot whirl pool baths
(spa, hot tub or bath tub) and
elevation and massage of feet (bed rest or recliner chair with 12 motor, 5 zone electric
vibrating massage
that extends to the lower legs and feet).
Multiple Botox injections every 3 to 4 months in the left foot sole to control excessive perspiration
instead of left side sympathectomy surgery. 400 units total of Botox each treatment.
See the following links for further information on the use of Botox to control Hyperhidrosis:
 |
1997 photo shows close up view of vascular support while standing.
If support is removed and R.M. stands up, the foot quickly changes skin color from
normal white, pink to abnormal red, purple and changes surface temperature from normal to noticeably
hot. |
LOWER LEGS: Limited exercise, swimming, walking, hot whirl pool baths, elevation and massage
of legs (bed rest or recliner chair with
vibrating massage).
CURRENT PAIN MEDICATIONS:
ALTERNATE, EXPERIMENTAL TREATMENTS: Bio-feedback, Physical Therapy including: Hand
therapy (massage), Hot whirl pool baths (limited effect, but regularity very useful),
Rolphing (useful, but excessively expensive), Myofacial therapy, Hospital P.T. Dept.
therapy, Chiropractic Therapy, Psychotherapy for pain management coping (not cure),
Hospital administered intravenous infusions (a failure and retrogression), Spinal
epidural injection, Acupuncture, TENs unit, Trigger point injections.
LONG TERM AND PRESENT CONDITION: Due to the severe frostbite injury, both his feet
sting, burn and sweat excessively. R.M. can not tolerate regular enclosed shoes and
must wear light weight open sandals with padded insoles. He can only tolerate
wearing sandals for short, limited periods of time. Therefore, R.M. removes his
sandals periodically throughout the day, particularly when sitting. His job
requires that he move around an office. The combination of sitting at his
workstation and moving around the office is beneficial and therapeutic for his
disorder. R.M. can not tolerate long periods of sitting, long periods of walking
or long periods of standing, but short periods of all in combination lessens the
daily aggravation of his pain disorder. Frequently, when he moves around the
carpeted areas of the office, he wears only socks on his feet. R.M. must remove
his sandals periodically to lessen severe foot pain.
Many other medications have been tried over a period of many years including
Neurontin, Prozac, Mexitil, Zoloft, Elavil, Propanolol (Inderal), Flexeril.
 |
1997 photo shows Wolky
brand leather sandals and thin light weight nylon dress socks. Right
side sandal has been altered to accommodate the shorter right foot. R.M. has had most success with
high quality european light weight leather sandals with closed cell form and leather insoles. |
Ordinary stress and pressure to perform quickly and manage multiple priorities at
work, home or other situations aggravates the vascular disease in his feet and
lower legs causing increased stinging, burning and aching.
R.M. finds that the interior environments (heating, cooling and ventilation systems)
at various locations are sometimes too warm for his special needs. Because of his
frostbite injury, his feet abnormally overheat, excessively perspire, sting and burn.
He must wear light soft open sandal shoes and light weight socks even in the winter.
Low ventilation (low air flow) and temperatures that are too warm, aggravate the
vascular disease in his feet. Average room temperatures that may be considered
normal to most individuals are sometimes too warm for his special needs.
Due to his chronic pain syndrome, which also includes spinal disease, R.M. was unable
to continue his full time employment in the Summer of 1994. He began working
half-time and was approved for supplemental long term disability insurance benefits
from the LTD coverage provided by his employer.
His various long term diseases and physical conditions have generally retrogressed
from 1974 to 2001. R.M. is currently 50 years old.
COMMENTS:
Individuals who have long term Neurovascular Dystrophy (RSD) in their feet and lower
legs and wish to discuss different medical treatments and practical day-to-day
considerations such as shoes, socks, vascular supports, exercise, walking, standing,
sitting, controlling foot temperature and pain management.
Doctors, other health professionals, or family members who have direct experience
treating, or caring for, individuals who have had long term Neurovascular Dystrophy
(RSD) in their feet and lower legs and wish to discuss different medical treatments
and practical day-to-day considerations such as shoes, socks, vascular supports,
exercise, walking, standing, sitting, controlling foot temperature and pain
management.
Please direct any comments to:
RPM@Spinn.net
LINKS:
Yahoo / Health / Diseases and Conditions / Reflex Sympathetic Dystrophy
RSD Hope: Maine RSDS web site
Case Study: Complex Regional Pain Syndrome
New Treatments for Reflex Sympathetic Dystrophy
Medical journal article abstract:
Medical journal article abstracts:
Ask NOAH About The Foot and Ankle
For Ever Free
Korean War Veterans' '50s Frostbite Injuries Return to Haunt Them
Post Traumatic Reflex Sympathetic Dystrophy: Problems of Diagnostics and Treatment
This page was last revised on: June 24, 2001
Comments on this Case History are welcome, especially from:
For more information concerning Neurovascular Dystrophy,
Reflex Sympathetic Dystrophy Syndrome, RSDS, Foot Disorders, etc. please refer to
the following links:
http://www.yahoo.com/Health/Diseases_and_Conditions/Reflex_Sympathetic_Dystrophy
http://www.rsdhope.org/
http://medoc-web.com/slid5963.htm
New England Journal of Medicine - August 31, 2000 - Vol. 343, No. 9
http://www.nejm.org/content/2000/0343/0009/0654.asp
Reflex Sympathetic Dystrophy.
A Review of the Literature and a Long-term Outcome Study
Reflex Sympathetic Dystrophy in feet
Great resource on illnesses, disorders and diseases
of the foot by the New York Online Access to Health (NOAH).
http://www.noah-health.org/english/illness/foot/foot.html
Dramatic story of a woman who suffered severe frostbite injury to her feet
in 1986 which resulted in long term RSDS.
http://www.geocities.com/HotSprings/4213/
THE CENTURION Newsletter for Oct-Dec 1996
by D.I. Ioffe. (text in Russian or English)
http://rsd-io.narod.ru/Index.html