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11 year old with heavy callous and HD's, unusual case

Discussion in 'Pediatrics' started by Sarah-Jane, Dec 17, 2009.

  1. Sarah-Jane

    Sarah-Jane Member


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    Hi all

    Had an 11 year old boy yesterday. He presented with heavy heavy callous on both 1st MPJ's (plus large fissure), 1st IPJ's, both heels, HD's both 5th MPJ's, pinch callous on lesser toes, some ID blisters. Has had this problem "for his whole life" as he said. Plays hockey a lot in the winter. In the summer he plays various different sports.

    Has virtually no problem with the feet during the summer months, callous almost disappears. But in winter it is a chronic problem. His feet are quite hyperhidrotic, mal odorous. Not much pain while I was reducing the lesions but cannot walk barefoot at home and wears runners all the time to provide more cushioning. Obviously wearing the socks and shoes all the time is contributing to the odour and sweaty feet but he cannot go without.

    His feet are still quite hypermobile, genu valgum, medially deviated STJ axis but not pes planus. He didnt write down his weight on the new patient form but I'm guessing he's about 140 pounds, about 5' 4". Very pleasant boy, didnt seem anxious although his Mam was very anxious to solve the problem obviously. He says it doesn't stop him playing hockey, he just gets on with it.

    He has been to see a dermatologist and other podiatrists. All of them say it is due to friction and abnormal foot motion and it certainly looks that way. He looks like he's been running a few marathons recently. I couldn't take any pictures but I hope to see him again in the next few weeks so I will try to take some then.

    I hope to get him into functional orthoses as he has never had them before. It would definitely help. I recommended some exfolliant lotions to see if it makes a difference. I think this is unusual in a child his age and just wondering if there's something else going on. He doesnt have any other medical issues. No lesions anywhere else on the body and no family history of dermatological problems......Anyone ever seen something like that before?
     
  2. Sally Smillie

    Sally Smillie Active Member

    I agree, it is unusual. I'd look at his metatarsal length too and the range of dorsiflexion he has in his mets. Perhaps an XR before prescribing orthoses. Also look at his plantar pressures. I have an archaic (although you can still buy them) thing which is basically self-adhesive plastic on carbon paper that they stand on and it gives a great impression of where most pressure is (in stance at least). intersting that the dermatologist had no idea
    Just a few ideas...
     
  3. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Given the seasonal nature of this condition, and the concomittant hyerkeratosis and malodour, I would suspect an infectious basis to this condition. Biomechanical features are clearly not affected by the seasons...

    The most common cause that would fit the patients symptoms would be pitted keratolysis - which can normally be treated very easily with topical erythromycin or clindamycin. Remeber to 'treat' the socks and hosiery too.

    LL
     
  4. posalafin

    posalafin Active Member

    Are the shoes he plays hockey on differnet to the shoes he plays summer sports in, especially does he wear tags/cleats for hockey? The position of the tags / cleats may be contributing to the HK ist MTPJ & HD's 5th MTPJ. Are the hockey boots a narrower fit than his other shoes that may be causing the pinch callous.
     
  5. PODKMM

    PODKMM Active Member

    I'm with Lucky Lis Franc. Water-based turfs could contribute to this also.
     
  6. Bug

    Bug Well-Known Member

    Another with LL. THe odour is hideous and the feet look like crumpets.

    I also find a 5% formalin in 70% alcohol works a treat however it is getting hard to find a chemist to mix it up for you.
     
  7. Sally Smillie

    Sally Smillie Active Member

    I'll never eat crumpets again!

    But why the HK being seasonal? Certainly the odour and damp fit the picture, but I still don't see why they might get the HK on and off

    You could also try a pale pink solution of potassium permaganate (condes crystals) - they are a little easier to get hold of, but still less than they used to be. Soak in that for 10 min a day
     
  8. Mankgabane

    Mankgabane Member

    I have seen a similar case with a 12year old girl, she does not play any sport and she is not overweight.She had abnormal wearing of shoes. In my case she had a lot of HK on the plantarmetatarsal area and medial aspect of the hallux in both feet.She also had a very servere pes-planus with the navicular almost touching the floor on weight bearing, but the MLA was flexible.The MLA formed of tip toe test.She also had bromhidrosis and hyperhydrosis that caused the HK to become maccerated.She did not complain of pain or iching.She defenaetly didnt have pitted keratolysis because o/e there was no pits or worm eaten appearence of the skin. I debrided the HK and prescribed orthotics, she has not come back for follow up. Thanks
     
  9. betafeet

    betafeet Active Member

    Just out of interest is there any tylosis to the rest of the body: palms, knees or elbows what is his family history/other sufferers.

    Jude
     
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