Persistent edema leading to subcutaneous scaring in healed diabetic foot ulcer: a case study of ultrasonographic findings

Background Subcutaneous fibrosis is a recognised complication following wound healing, mainly caused by persistent edema. It causes irreversible changes to the anatomical structure of the foot risking recurrent foot ulceration and lowering the quality of life. However, its identification may be challenging due to it having similar features to edema. This case report highlights the ultrasonographic characteristics of phlebolymphedema-related subcutaneous fibrosis following the healing of an infected diabetic foot ulcer. Case Presentation A 50-year-old male patient with diabetes presented with persistent swelling on the dorsal aspect of his right foot after healing of an infected ulcer, complicated by non-compliance with edema management. Ultrasonography revealed extended adipose globules with low echogenicity in the interstitial spaces and foci of pooled fluid, suggesting subcutaneous fibrosis. In contrast, a comparative case of edema without fibrosis showed diffusely distributed anechoic interstitial fluid. Conclusion This case underscores the utility of ultrasonography in detecting subcutaneous fibrosis, a potential long-term consequence of persistent edema during wound healing. Early recognition through imaging can guide timely intervention and appropriate management strategies to mitigate functional impairments associated with this complication.