Hot water bottles and diabetic patients--a cautionary tale.

bottle under his left foot. He woke up one morning and noticed burns on the lateral aspect of the foot. He did not seek any medical help and chose to dress the burn himself. After 2 weeks he noticed a foul smelling discharge from the wound and went to the Accident and Emergency (A&E) department. He was subsequently referred to our hospital department of plastic surgery. On examination he had a large burn on the lateral aspect of the left foot with a thick leathery eschar, which was starting to separate. There was also purulent discharge from the wound, as well as surrounding erythema (Figure 1). He was treated with antibiotics and dressings and was taken to the operating theatre after a few days for debridement of the burn and split skin grafting. The graft was inspected after 5 days and was found to have taken well. The second patient was a 57-year-old man with non-insulin-dependent diabetes mellitus, who was taking metformin and rosiglitazone and who also had peripheral neuropathy to both feet. He stated that he had not received any specific advice about avoiding accidental injuries to insensate body parts. He used a hot water bottle filled with water from a kettle for warming his feet. He had slept with the bottle between his feet and woke up one morning to notice burns over both feet. He went to the nearest A&E department and was referred to our unit subsequently. On examination he had burns over the lateral aspect of his left foot and the medial aspect of his Rajive Mathew Jose, Ramesh Vidyadharan, Deb Kumar Roy and Matt Erdmann