Infections and Open Sores Prior to Surgery

Abstract

In February of 2025, I was in the process of scheduling surgery to replace a broken pacemaker wire. My pacemaker physician and his nurse both advised that I not go into surgery with any infections or open sores anywhere on my body. Unfortunately, I had an inflamed and infected toe that I had been treating myself unsuccessfully for the past several months. They referred me to a Podiatrist. This article is about a toe that simply does not want to heal even with the help of a Podiatrist.

Keywords:Fatigue, Lack of energy, Infections and open sores prior to surgery, Podiatrist, Morton’s Toe

Background

I have a foot disorder colloquially known as Morton’s toe. This is where the second toe on each foot appears longer than the big toe. (Technically, it is known as a form of brachymetatarsia.) It got its name of Morton after an American doctor who first described it in the early 20th century. The subject of toe shape has been around for thousands of years, and there are a number of differently shaped feet. The “Greek foot” contains a Morton’s toe. The Statute of Liberty, for example, was cast with Greek feet that are 25 feet long.

The toe next to my big toe on my left foot has been sore and infected three times in the last two years. The first two times it was infected, I treated it myself with antibiotic ointment and band aids, and it took several months each time for it to clear up. After the toe became inflamed a third time, I realized the condition had become chronic and needed treatment beyond what I was able to provide on my own. In addition, as discussed below, the infected toe was threatening to prevent or delay needed surgery to replace a broken wire in one of my pacemaker’s leads.

A Broken Pacemaker Wire

It was a broken pacemaker wire that became the impetus for me visiting a Podiatrist about my toe. During the months of December 2024, and especially the month of January 2025, I noticed a big drop-off in my energy level. I could not walk far without needing to stop to catch my breath.

In December of 2023, I had received a new biventricular pacemaker. I got this pacemaker because I had been lacking energy and was short of breath when walking. After getting the biventricular pacemaker in December of 2023, I felt much better, and my energy level returned to normal for me. Less than one year later, my energy level had dropped off again. I was worried that something new might be wrong with my heart, because I had gone from normal energy to a total lack of energy. I was reluctant to mention this lack of energy to my pacemaker physician as I was afraid he would feel the biventricular pacemaker was a wasted effort. However, I did mention it, and when he tested the pacemaker in February of 2025, he found a broken wire in the lead going to the left ventricle of my heart. In short, the biventricular aspects of my pacemaker were not working at all. I am pacemaker dependent, which means that I cannot live without a pacemaker. The pacemaker keeps my heart beating. Family and friends wondered how I could live with a broken pacemaker wire since I was pacemaker dependent.

Interestingly enough, the broken wire was going to the left ventricle of my heart. When the wire broke, the left ventricle picked up a signal to beat from the nerves in the right ventricle. So, the left ventricle was beating, but it was beating a fraction of a second behind the right ventricle. This, apparently, was the cause of my fatigue, and a decision was made to replace the lead with the broken wire inside it. Replacing my broken pacemaker wire required surgery. My pacemaker physician made it clear to me that he would not perform surgery if I had an open wound or infection anywhere on my body. Therefore, I needed to get the infected toe treated by a Podiatrist. I was reluctant to see a Podiatrist because I had heard that many people who receive treatment from a Podiatrist are unable to walk and exercise for an extended period of time. They get out of shape and many are never to regain physical fitness after being off their feet for extended periods of time. In my case, I figured that I had little to lose by visiting a Podiatrist as my energy level was so low from my pacemaker issues.

My Podiatrist said there was not much of a chance he could heal the infection on my toe without removing the toenail, and I allowed him to do so in February of 2025. Within a short period of time, the Podiatrist said it would be okay for me to get the surgery for my new pacemaker lead, and I got the new pacemaker lead in February of 2025. Unfortunately for me, the wound on my toe in and around where the Podiatrist had removed my toenail refused to heal. See the diagram of my toe still unhealed after four months. Also, unfortunately for me, my energy level has not returned to normal for several additional reasons besides the broken pacemaker wire.

Additional information taken from my pacemaker showed that I have Atrial Fibrillation (AFib). In my case, AFib is a condition where the heart beats irregularly causing me to feel tired most of the time. An additional test, a form of an Echo Cardiogram called a TEE, showed that I have a blood clot lodged in the left ventricle of my heart. Apparently, this clot is impeding blood flow throughout my body and is an additional cause of my fatigue. I have been prescribed an anticoagulant to hopefully prevent any more clots from forming. It is hoped after five months or so that I will be able to have a heart procedure called an ablation to cure the AFib. In the meanwhile, my pacemaker physician has turned off all special features of my pacemaker as a safety precaution, and my pacemaker is now operating in a very limited fashion. Having my pacemaker set only on bare basics of its true capacity also is contributing to my feeling fatigued.

A Family History of Toe Problems

I’m not the first in my family to have toe problems. I’m going to start this section by telling you about my grandfather’s toe. This story goes back 70 years or more, so my memory is not completely clear on all the exact facts, but I have the essence of the story correct. My granddad had a sore toe, I think not dissimilar to my sore toe. I’m not sure which foot or which toe. I want to say it was the big toe on his left foot, but that may be just a guess at this point. Anyhow, when his toe got nice and infected, he would pull the toenail out himself with a pair of pliers. He did not just yank the nail out, but he would gently pull and wiggle the toenail with the pliers until he finally had it out. I don’t remember how long it took him to pull the toenail, but I’m thinking 30 to 60 minutes. No deadening of the area, just keep wiggling and pulling the nail until the pain was too much, rest awhile, and then more wiggling and pulling until he got the nail completely out. I remember my grandmother saying to me, “It’s going to be a rough few days around here. Your grandfather is getting ready to pull out his toenail.”

My grandmother, his wife, would cut some small pieces of cloth for him to wrap around his toe after he had pulled out his toenail, and then he would pour turpentine into the cloth. He kept fresh pieces of cloth soaked in turpentine on the toe for a few days. After about three days, his shoe went back on, and he went back to work. He owned a small grocery store. Over time, maybe a year or so, or slightly longer on occasions, the toenail would grow back and become infected, and he would go through the whole process again. This was a ritual he went through for the last 20 years of his life, and I don’t know how many years before that. Turpentine was his “medicine” of choice for all wounds and many illnesses. I once saw him smash his thumb quite severely with a hammer when he was trying to drive a nail into a board and missed the nail with the hammer and hit his thumb instead. I always learned new cuss words when incidents like this took place. He wrapped the thumb in a small piece of cloth and poured turpentine into the cloth. After the pain had somewhat subsided, he went back to nailing the board he had been working on when he first hit his thumb with a hammer. Unfortunately, he missed the nail and hit his thumb a second time. Newer cuss words. He was building a house in the country, and he was in his retirement years, and I suspect his eyesight was off a little. More cloth and turpentine seemed to take care of the problem. Remember, I was just a little kid watching all of this with big eyes and hurting for him myself. The thumb looked horrible.

He even gargled with turpentine if he had a sore throat. A physician once told him that he should not gargle with turpentine, that if he accidently breathed in any turpentine fumes, he could severely damage his lungs maybe leading even to death. He was very careful after that to never breathe or cough while gargling.

It is sometimes mistakenly believed that turpentine is distilled from petroleum because it has been used with paint products in the past. Actually, it is distilled from pine tree sap. Nevertheless, it is highly toxic and no longer used in medicinal products as it once was. At least three other members of my extended family have toe problems similar to mine. All three have sought medical help. Two of the three decided against medical treatment after consultation with a Podiatrist, one received medical assistance. Like me, all three continue to have medical problems with one toe (Figure 1).

Figure 1:

Going Forward

So, my toe is getting better. Hopefully within a few more weeks, the wound will be healed over. Hopefully, I will eventually have the ablation without worrying about an infected toe or a toe with an open wound. Once the ablation is complete and the AFib is under control, I can begin some rehabilitation to restore my physical capacity. At least that is my plan.

Acknowledgement

None.

Conflict of Interest

None.