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Advice with patient with unusal painful lesion/area

Discussion in 'General Issues and Discussion Forum' started by peter mccloskey, Nov 23, 2012.


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    I saw this 37 year old patient today who presented with a red, painful swelling on the plantar surface of his right foot distal to the metatarsal head of 24 hours duration. I expected there to be an inter-digital fissure or wound which might have been a portal of entry for infection. However the skin was intact and I was baffled. He has had 3-4 similar episodes in the last year when the pain and swelling subside after a few days. He practices non-traumatic exercise like tai chi and yoga. He has been to his GP who was no help and did not take it further. His left heel around dorsal/plantar skin junction is also painful and hurts when he puts his shoes on and when he walks. No skin lesions,redness or swelling were visible on the heel but it was noticeably warmer than the right heel. I suggested he return to his GP and ask for some blood tests and Xrays. Possible diagnosis of reactive arthritis? Any ideas?
    The attached photo was taken with the patient's iphone as my camera didn't take a brilliant snap.
     

    Attached Files:

  2. Craig Payne

    Craig Payne Moderator

    Articles:
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  3. davidh

    davidh Podiatry Arena Veteran

    You beat me to it!

    On that note our fishery bailiff asked me about his feet the other day. He has type 2 diabetes, but is otherwise very fit. He gets chilblains every year about the same time which take ages to clear up. He works in and around water and continually gets his feet wet. I asked him what he did about them. He told me the only thing which seems to help is soaking them in hot water:eek: with a splash of Dettol every night.

    We changed his boots for something waterproof, and stopped the hot water soaks. The chilblains are clearing already!

    Since the consultation was made at the side of the river, and the advice given likewise, I didn't charge for my services:D.
     
  4. Ian Linane

    Ian Linane Well-Known Member

    Since the consultation was made at the side of the river, and the advice given likewise, I didn't charge for my services.

    Sounds like you're getting soft David;)
     
  5. davidh

    davidh Podiatry Arena Veteran

    Well something had to come with age, and it certainly hasn't been wisdom!:D
     
  6. No it's not a chilblain. It was the painful heel that made be think of arthritis but the intermittent nature didn't seem to fit. I hope he returns with the results of his tests.Thanks
     
  7. blinda

    blinda MVP

    Hi Peter,

    I agree, further investigation in the form of blood tests, etc is warranted. Secondary causes of erythema include;

    • RhA
    • liver disease
    • malignancy
    • thyroid disorder
    • reaction to meds

    From the pic and info you supplied, it looks very much like erythema nodosum, although this usually manifests on the legs.

    Keep us posted :drinks

    Cheers,
    Bel
     
  8. I had the patient's folder in my hand as he just walked in which is a strange coincidence. He wanted to know what pod arena thought. When he presented , four days ago,I ultrasounded the swelling and offloaded it with felt padding. That seemed to have helped. He asked me to write to his GP to help with his request for blood tests which I shall do today. I'll let pod arena know the results in due course. Thanks
     
  9. dazzalyn1

    dazzalyn1 Member

    Could it be somthing simple, perhaps to do with Tai chi and yoga being practiced in bare feet with friction from the types of movements undertaken in these exercises? Maybe it's the photo but I can only see a slight pinkness there.
     
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