This report describes a rare case of bilateral foot burns in a 61-year-old man following a religious firewalking ceremony, an event scarcely documented in the literature. The patient presented with multiple painful foot blisters and ulcers 2 days after the ceremony, accompanied by marked discomfort and impaired mobility. On examination, the right foot showed a large deroofed blister with mild slough, whereas the left foot had an intact, tense bleb. The primary diagnosis was bilateral foot burns complicated by diabetes mellitus. Management included deroofing and dressing the right foot blister, while the left foot blister was aspirated, enabling a direct comparison of two treatment strategies within the same patient. Glycemic control was optimized by adjusting insulin dosages, and wound care was tailored to the clinical condition of each foot. Early multidisciplinary consultation guided infection monitoring and pressure offloading. The outcomes underscored the challenges of burn management in diabetic patients, particularly with regard to delayed wound healing and heightened infection risk. This case highlights the importance of individualized burn blister management and the methodological value of comparing deroofing versus aspiration in a controlled clinical context. The key implication is the need for further research to establish best practices for burn care in high-risk populations, especially following unusual injury mechanisms such as firewalking.

This is a case report of a developmentally healthy 14-month-old female with partial thickness scald burns at multiple sites (the face, trunk, and bilateral upper extremities) that covered 14% of her total body surface area. Novel procedural pain therapy using intravenous lidocaine and oral ketamine was administered to perform daily wound care with minimal discomfort. Following this daily analgesic protocol there was sufficient analgesia and sedation with no adverse side effects. Currently, there are no studies where this analgesic combination was used during burn wound care and dressing changes in pediatric cases. The success of this protocol in a pediatric case highlights the safety and efficacy of oral ketamine when used in conjunction with intravenous lidocaine which potentially allows for a lower dose per procedure and a reduced risk of adverse effects.