Dog bites and diabetic peripheral neuropathy: a dangerous combination

Abstract

All animal bites have the potential to cause significant infection. In the UK, dogs are the most common source of bites. Incidence of hospital attendances attributable to dog bites has risen over the last decade. Patient groups at particular risk of bites and/or complications of infection include those at extremes of age, immunosuppressed and patients with diabetes. We report the case of a patient with diabetic peripheral neuropathy, who was admitted on two separate occasions with unprovoked bites to his toes whilst asleep, by his pet dog. He ultimately required terminalisation of the affected digits. Although unusual, this mechanism of injury has been previously described in literature. However, we are unaware of cases reporting multiple separate incidences involving the same patient and animal. We present this case to highlight the perils of untrained pet ownership in diabetic patients with peripheral neuropathy and the importance of prompt medical and surgical treatment of injuries.

The reported external traumas among people with diabetes‐related foot ulcers and their outcomes: A systematic review of case reports

“…Indeed, foot care practices included external traumas related to the actions/advice of healthcare professionals (6.7%, n = 9). Actions/advice of healthcare professionals included a radiant burn from drying a wet plaster cast with a hair dryer, another example included friction from compression stockings or Plaster of Paris casts 34,48,50,80 …”

“…Rat bites during sleep 19,20,36,40,52,58,59,63,94 Pet dog chewed all toes over a 4-month period a 4 independent occasions 25 Pet dog chewed right hallux, right second and third toes a two independent occasions 80 Pet dog chewed left hallux 87 Pet cat chewed toes of right foot 51 Friction Badly worn orthoses 66 Deep neuropathic ulcer from shoe caused Achilles tendon to rupture 90 Friction from beach shoes 26 Friction from plastic beach shoes a95…”

“…Ill-fitting shoes and socks 81 Ill-fitting shoes on the sole of foot near the heel 47 Inappropriate footwear and self-treatment without using medical products-three independent ulcers 56 New hiking boots 84 New shoes 42,104 New Slippers 37 Plaster cast for a fracture 14,80 Plaster of Paris cast 34 Removed callus with over-the-counter adhesive plaster 68 Rolled edge of compression bandage 48 Sandal strap caused wound 26 Worn lining of surgical shoes caused blisters on toes 100 Blunt force trauma Bruising from car accident 35 Accidentally kicked a locker 44 Car keys had fallen into shoe avulsing toe nail 76 Bumped foot into a cabinet 79 Barefoot walking on rough surface a26…”

“…Actions/advice of healthcare professionals included a radiant burn from drying a wet plaster cast with a hair dryer, another example included friction from compression stockings or Plaster of Paris casts. 34,48,50,80 Further examination of the identified categories showed that external traumas varied by cultural context and/or geographical location. For example, pets were the source of external trauma in very high Human Development Index countries (mainly the United States of America [USA] and the United Kingdom [UK]) and rat/mouse bites were a named cause of trauma in very high and high Human Development Index countries and urban areas of medium and low Human Development Index countries.…”

Microbiological Characteristics and Surgical Management of Animal-Bite-Related Oral & Maxillofacial Injuries: A Single Center’s Experience

“…Different studies have recognized that prophylactic antibiotic therapy—except for bite wounds of the hand—did not achieve any advantage over placebo [ 26 , 27 ]. Other studies declared that an antibiotic therapy for facial bite wounds is necessary [ 28 , 29 ]. Preventive antibiotic therapy should also be considered for certain risk factors.…”