Plantar Abscess - an Unusual Initial Presentation of Diabetes Mellitus

A 56-year-old male presented with left heel pain, redness, swelling, without any fever, with a background history of hypertension. There was no history suggestive of diabetes or heart disease. Ultrasound imaging revealed a thickened plantar fascia with inflammatory changes and fat pad thickening. Magnetic resonance imaging (MRI) of the foot confirmed subcutaneous pus collection. Routine investigations revealed very markedly uncontrolled blood sugar levels. Drainage of pus with incision and debridement was carried out, and antibiotics, along with diabetic medications, were administered. Culture was suggestive of methicillin-resistant Staphylococcus aureus (MRSA), for which appropriate antibiotics were initiated, bringing the infection under control. The patient with high blood sugar presented with a plantar infection without any prior symptoms of diabetes mellitus. In this case, the first symptom of diabetes was an infection/abscess in the plantar fascia – a rare site of infection.