Cellulitis On Foot

[LIVES4SHARKS]

I dove W. Palm back in June of this year and within 48hrs developed severe cellulitis and blisters. I was put on antibiotics and stayed out of the water for 2 mos. until all wounds were healed. I had attributed the infection to blisters I had received from my fin straps. I had dove in SW back in March in the Bahamas without trouble. I have dove the springs in Florida without trouble. I have gotten new booties and spring straps and now dive with nylon socks to reduce the risk of blisters from rubbing. I dove Boynton Beach this past Sunday and within 24hrs started to develop the same pain and swelling on the same foot, this time at my 3rd toe and my inner heel. I did not have any cuts or blisters this time and had no pain after getting off the boat. I am now on antibiotics again to keep this from becoming a mess like last time. I had not sought treatment for the first infection for 4 days after the dives. This time I didn't let it get any worse than the redness, pain, and soft tissue swelling. There is no external blistering at this point. My physician is at a loss at why this is happening. It could be coincidence, but looking that I was just South of the prior area, I am not sure if there is a correlation. Is anyone else experiencing this problem? I am not diabetic, or have any circulation problems. I am just trying to avoid this happening again. I appreciate any help or information.

Thanks!
Carolyn

 

[PfcAJ]

Was a culture done?

The water could be weakening your skin, possibly allowing for an infection to take hold. Just a thought.

 

[LIVES4SHARKS]

No cultures done. I think my next option is to go to a podiatrist if this occurs again. My primary doctor is at a loss. It's just strange that it is affecting the same foot each time.

Carolyn

 

[TSandM]

Well, when things occur that are odd, the first thing is to question one's assumptions.

Is this actually an infection, or is it an inflammatory response of some other kind? Since it occurred twice in the same area, is there some organism in the water to which you are reacting? That would not, however, explain why it occurred in the same region.

Another possibility . . . Was the original infection not completely eradicated? One wonders about deep extension -- an abscess, or involvement of the bone. Or a foreign body that was overlooked, like a splinter of some kind.

I'd raise the possibility that the fin simply doesn't fit that foot, except you said the skin was unbroken this last time (no abrasion or blister).

If this continues to happen, I think cultures would definitely be in order, if there is any fluid or tissue that can be cultured. One might also think of a CT or MRI of the foot, to detect any abscess or fluid collection and to look for a foreign body, or a bone scan done once the superficial infection is controlled, to see if there is any suggestion of osteomyelitis.

At least these are some avenues that would occur to me, if I were trying to sort this out.

 

[Scubakevdm]

I dove W. Palm back in June of this year and within 48hrs developed severe cellulitis and blisters. I was put on antibiotics and stayed out of the water for 2 mos. until all wounds were healed. I had attributed the infection to blisters I had received from my fin straps. I had dove in SW back in March in the Bahamas without trouble. I have dove the springs in Florida without trouble. I have gotten new booties and spring straps and now dive with nylon socks to reduce the risk of blisters from rubbing. I dove Boynton Beach this past Sunday and within 24hrs started to develop the same pain and swelling on the same foot, this time at my 3rd toe and my inner heel. I did not have any cuts or blisters this time and had no pain after getting off the boat. I am now on antibiotics again to keep this from becoming a mess like last time. I had not sought treatment for the first infection for 4 days after the dives. This time I didn't let it get any worse than the redness, pain, and soft tissue swelling. There is no external blistering at this point. My physician is at a loss at why this is happening. It could be coincidence, but looking that I was just South of the prior area, I am not sure if there is a correlation. Is anyone else experiencing this problem? I am not diabetic, or have any circulation problems. I am just trying to avoid this happening again. I appreciate any help or information.

Thanks!
Carolyn

I'm in the water almost every day in Boynton, with all kinds of cuts and scrapes and haven't run into anything wierd.

 

[LIVES4SHARKS]

Thank you TSandM, I will make a follow-up appointment with a specialist and see if there is something they can take a sample of. It is like pockets of cellulits...very painful but the swelling isn't as intense this time. But, I went to the Doc immediately this time rather than wait. The original infection cleared up completely and the symptoms subsided by the 3rd day of antibiotics. I stayed out of the water until all the skin was compltely healed. This was the first time I had been in salt water since the original infection in June. I will take your advice for further examination and go from there. I really appreciate your help.

Thanks for the info Scubakevdm. I definitely want to get back on your boat again!

Carolyn

 

[fisherdvm]

I wonder about stasis dermatitis and its manifestation with lipodermatosclerosis, or what some call sclerosing panniculitis.

Other things to consider include erythema nodosum, pyodermagangrenosum.

A good dermatologist might be needed. If you have frequent swelling of your ankles and varicose veins, you might consider conservative treatment with support stockings.

 

[LIVES4SHARKS]

Thank you fisherdvm. The thing is, I have never had this type of infection before. I have only had it 2x, after diving W. Palm and Boynton Beach. I have never had any trouble in the springs or diving in the Bahamas. I will be diving Pensacola this weekend, the infection is completely gone and no open blisters or wounds this time around. I will be diving in LaPaz in December, so we shall see if this is associated with where I am diving, or just diving SW. I do not have cellulitis or edema on a regular basis. My other foot is fine, and has shown no sign of infection. It is all too weird. But I will keep track and keep following up after any other problems.

Thanks again!
Carolyn

 

[Scubasw]

Had the same thing back in the spring after a week in the Bahamas. Just after returning I had the blisters in the joint of the last three toes and foot and in between the toes. I had been diving 4x a day for a week. I thought maybe it was just a skin irritation from so much salt water contact and wearing booties all day. Went to the doctor who did blood work (no infection) and a number of other tests all of which came back negative. At first just had me keep it dry and use a topical ointment. After a week my foot started swelling noticibly. She did more blood work, still no infection and put me on three different antibiotics including IV in the office. Also had me wear a support hose to put pressure on the foot to reduce the swelling. There wasn't much pain, but the whole foot was visibly fluid swollen. After a week the support hose reduced the swelling , buit within 2 days after stopping it's use the swelling returned. During this time I stopped diving, kept the foot dry, no other socks or shoes. The blisters continued to return cycing between almost completely healed and then suddenly opening up again. I contined to use the topical ointment and also used Tinactin. The Doctor still hasn't figured it out and said it woudn't hurt. After several months all the open wounds have finally closed, but I just noticed a small blister the other day which only lasted a day and then closed up in a day or two. My foot seems to be back to normal, other than some strange tingling in the tips of my toes at times. The doctor still can't give me a specific diagnoses other than the "cellulitus" which is just generic for "open wound, we don't know why!"

X-rays showed nothing embedded in the tissue. I'm back to diving, but mostly in a dry suit for now.

 

[Fuzzmutton]

Hi Carolyn!

My son was just diagnosed with cellulitis of the toe, so I started reading up on it. I think TSandM was onto something about the origianl infection maybe not being eradicated. The material I read said something about cellulitis returning, even after EXTENSIVE periods of time, if not treated effectively the first time.

Fuzz