1002 - Third-Degree Pavement Burn Injury During Wheelchair Propulsion in a Patient with Diabetic Neuropathy

Case Diagnosis: Third-degree pavement burn injury of the right foot in a 50-year-old female with diabetic neuropathy (DN).

Case Description: A 50-year-old woman with morbid obesity, HTN, asthma, a-fib, type II DM with DN, and status post left below-knee amputation, presented with a third-degree burn of the right foot complicated by cellulitis. She used a wheelchair for mobility and propelled herself with her right leg. On a hot summer day, she propelled herself around her mobile community in her wheelchair wearing only socks. Due to neuropathy, she was unable to perceive the pavement temperature. The next day, she noted drainage from the plantar surface of her foot, revealing the injury. She attempted self-care for six days before presenting to a local hospital, and was transferred to burn center as the wound worsened. Examination showed third-degree burns of the plantar with surrounding cellulitis. She was treated with antibiotics, daily wound care, and admitted to inpatient rehabilitation due to impaired ADLs.

Discussions: Peripheral neuropathy, a common complication of diabetes, predisposes patients to unrecognized thermal injury. Scald burns are well documented, but pavement burns are typically reported in patients incapacitated by trauma, acute illness, or drug-induced unconsciousness. In contrast, our patient was fully conscious and mobile, sustaining the injury while propelling a wheelchair—an unusual mechanism not well described in the literature. Harrington demonstrated asphalt and cement may reach 68 °C and 60 °C at ambient temperatures of 35–37.8 °C, enough to cause third-degree burns. Maghsoudi reported higher infection risk in diabetic burns, and even small TBSA burns may require intensive care and rehabilitation due to comorbidities.

Conclusions: This case highlights hot pavement as an underrecognized cause of severe burns in ambulatory diabetic patients with neuropathy, particularly with minimal foot protection. Physicians should counsel diabetic patients on proper footwear and the risk of thermal injury from outdoor surfaces.