Managing a Blood Blister on an Elderly Diabetic Patient's Foot: What to Do?

Hello, doctor. I would like to inquire on behalf of my father. There is a bruise-like lump the size of a soybean on the side of his left foot near the big toe joint?

Hello Doctor, I am inquiring on behalf of my father.
He is currently 78 years old and has diabetes, which he manages through diet without medication.
On the side of his left foot near the big toe, he has a long-standing habit of trimming thick skin in that area, which does not exhibit symptoms similar to a corn and is not painful.
The last trimming was about a month ago, and there was no skin break or bleeding at that time.
However, a few days later, it developed into a small bruise, and after a few more days, it turned into a bruise that is about the size of a soybean.
The bruise protrudes about 0.3 cm above the skin surface.
Currently, it is neither painful nor itchy, and it does not significantly affect his ability to walk or wear shoes.

Since my father is currently overseas where the pandemic is severe, all general clinics are closed, and it is not suitable for him to visit a large hospital for an appointment.
I would like to ask an online doctor: if he is to care for it at home, how should he proceed? Should he use a disinfected needle to puncture and drain the bruise? Or can he simply leave it alone and wait for the bruise to shrink over time? If it accidentally breaks and bleeds, how should he care for it? Is it necessary to drain the bruise? I apologize for asking so many questions, as my father is quite worried.
Thank you very much for your time and assistance.

Joel, 40~49 year old female. Ask Date: 2020/05/23

Dr. Wu Yuxin reply Dermatology

For the general public, it may not be a significant issue, but since your father is a diabetic patient, I recommend not to take it lightly.
It is advisable to seek medical attention.

Reply Date: 2020/05/23

More Info

Managing a blood blister, especially in an elderly diabetic patient, requires careful consideration due to the potential for complications. In your father's case, the blood blister near the toe, which has developed after trimming thick skin, is concerning, particularly because he has diabetes. Here’s a comprehensive approach to managing this situation.

Understanding Blood Blisters
Blood blisters occur when blood vessels under the skin break, leading to a collection of blood between the layers of skin. They can form due to friction, trauma, or even from underlying conditions that affect circulation, which is particularly relevant in diabetic patients. Given your father's diabetes and the fact that he has a history of thick skin in that area, it’s essential to monitor the blister closely.

Initial Assessment
1. Observation: Since the blister is not painful or itchy and does not interfere with walking, it may not require immediate intervention. However, it’s crucial to keep an eye on any changes in size, color, or symptoms like pain or warmth, which could indicate infection.

2. Hygiene: Ensure that the area around the blister is kept clean. Regularly wash the foot with mild soap and water, and dry it gently. Avoid using harsh chemicals or alcohol, as these can irritate the skin further.

To Drain or Not to Drain
There is often a debate about whether to drain a blood blister. Here are some considerations:
- If the blister is small and not causing discomfort: It is generally advisable to leave it intact. The skin over the blister acts as a natural barrier against infection, and allowing it to heal on its own can be beneficial.

- If the blister is large or painful: If you decide that draining the blister is necessary, it’s crucial to do so safely:
- Sterilize: Use a sterilized needle or a sharp object that has been cleaned with alcohol.

- Puncture: Gently puncture the blister at its edge to allow the fluid to escape. Avoid removing the overlying skin, as it protects the underlying tissue.

- Drain: Allow the fluid to drain out completely, but do not force it.

- Cover: After draining, cover the area with a sterile bandage to protect it from dirt and bacteria.

Aftercare
1. Monitor for Infection: Watch for signs of infection, such as increased redness, swelling, warmth, or pus. If any of these symptoms develop, seek medical attention promptly.

2. Moisture Control: Keep the area dry and change the dressing regularly. If the blister has been drained, it may need to be covered for several days until it heals.

3. Avoid Pressure: Encourage your father to avoid putting pressure on the blistered area. If necessary, consider using cushioned pads or changing footwear to reduce friction.

4. Diabetes Management: Ensure that his blood sugar levels are well-controlled, as high glucose levels can impair healing and increase the risk of infection.

When to Seek Medical Attention
Given your father's age and diabetes, it’s always better to err on the side of caution. If the blister does not improve, shows signs of infection, or if he experiences increased pain or swelling, it’s essential to consult a healthcare professional. While in-person visits may be challenging due to the pandemic, many healthcare providers offer telehealth services that can provide guidance without the need for physical visits.

Conclusion
In summary, managing a blood blister in an elderly diabetic patient involves careful observation, maintaining hygiene, and deciding whether to drain the blister based on its size and symptoms. Always prioritize monitoring for signs of infection and ensure that diabetes is well-managed to promote healing. If there are any concerns, do not hesitate to reach out to a healthcare provider for advice.

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