Black necrotic second toe in an elderly diabetic female: dry gangrene with autoamputation

¹Department of Rasashastra Evam Bhaishajya Kalpana, Mahatma Gandhi Ayurveda College Hospital and Research Center, Datta Meghe Institute of Higher Education and Research, Salod, Wardha, Maharashtra, India

^&Corresponding author
Anita Santoshrao Wanjari, Department of Rasashastra Evam Bhaishajya Kalpana, Mahatma Gandhi Ayurveda College Hospital and Research Center, Datta Meghe Institute of Higher Education and Research, Salod, Wardha, Maharashtra, India

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A 72-year-old female presented with blackish discoloration and coldness of the second toe of the left foot for one month. She was a known case of diabetes mellitus with poor glycemic control. The condition initially presented as mild pain in the affected toe, which gradually progressed to discoloration followed by loss of sensation. There was no history of trauma, fever, or similar lesions. On examination, the second toe appeared blackish, dry, and shriveled with a hard, mummified texture. A well-defined line of demarcation separated necrotic tissue from the surrounding viable skin at the metatarsophalangeal joint. Mild edema was noted, and peripheral pulses were reduced. A clinical diagnosis of dry gangrene was made. The patient was managed conservatively considering the stable nature of dry gangrene and the presence of a well-defined line of demarcation. Strict glycemic control was achieved to prevent further progression of ischemia. Antiplatelet therapy was initiated to improve peripheral circulation. The affected toe was kept dry and protected, and regular local wound care was performed to prevent secondary infection. The patient was closely monitored for any signs of infection or conversion to wet gangrene; however, no such complications were observed. Over time, the lesion progressed with extensive necrosis and subsequently underwent auto-amputation at the line of demarcation. The residual stump showed healthy granulation tissue with satisfactory healing. Dry gangrene results from prolonged ischemia and is commonly seen in diabetic patients due to peripheral vascular insufficiency. This case highlights the classical progression of dry gangrene leading to autoamputation.

Figure 1: clinical progression of dry gangrene of the second toe of the left foot; A) initial stage showing blackish discoloration and early mummification of the second toe; B) advanced stage showing extensive dry gangrene with a clear line of demarcation; C) post-auto-amputation stage showing separation of the digit with a healthy granulating stump