A 67 year old man presents with chronic case of bilateral lymphedema. The patient has several serious medical problems including CHF, diabetes mellitus, a Whipple procedure for carcinoma of the pancreas 14 years ago, and morbid obesity. He also had an amputation of second and third digits of the left foot. I am surprised that he gives not history of previous ulcerations with the degree of lymphedema that he presents with. On exam he has decreased sensation in the feet. A diagnosis of severe onychomycosis and xerosis was made. The patient was instrcuted that he should not ambulate wihtout shoes. I do not think that his feet would fit into a standard pair of diabetic shoes. What else can we do for this man?
