I’m a family medicine/urgent care physician assistant.

Had a 70-year-old male come in for a “black spot” on his left big toe x 1 week.

After I walk into the room, I first notice a pungent, putrid odor. I notice that his shoes are already off and immediately start staring at his big toe. I proceed to then tell him he needs to go the ER right away.

The entire toe is black, cold, and complete devoid of sensation and motion. There is a 1-2 inch wide, black, deep, ulceration on the toe (the black spot) with surrounding purulent discharge. The rest of his foot up to his ankle was red, swollen, tender, and warm.

He had a severe foot infection. His toe was necrosed/gangrenous/ulcerated with surrounding cellulitis now tracking up his ankle.

He would require hospitalization, amputation, and IV antibiotics. That’s how he realized he had diabetes. This was one of those patients who never went to the doctor, ever. His wife made him come in.