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Hello Pod Friends! Happy friday! I wanted to pick your brains regarding a case that has wandered into my clinic.
A 20 something young woman has presented with a painful Left lateral ankle in the heel pad area just superior to the plantar aspect of the heel pad. There is pain on direct palpation of the area.
The pain has been present for approximately 3 weeks.
The patient remembers no specific trigger of the pain and erythema onset.
There is red demarcation and inflammation that spreads out in a irregular shape approximately 6cm x 4cm in area (the erythema is of a spidery appearance, if that makes sense!).
The pain is most prominent for the patient when weightbearing without shoes or with hard soled shoes. (There is no plantar fascia, achillle's or ankle pain present).
I referred the patient for an ultrasound as i suspected a foriegn body present. The ultrasound has revealed no echoiec foriegn bodies or loculated collections just inflammation present.
I am now thinking a spider bite could possibly the cause of this?
Does anyone have any other differential diagnosis, examination recommendations or have seen something of a similar nature? I would greatly appreciate it cos i am :craig: at the moment!

Thanks in advance,

Natalie W

 

My first reactions was chilblains (think of horses and not zebras)... but I know from your IP address, you are in Australia and its the wrong time of the year!

Consider it could be erythromelalgia (think of zebras and not horses)

Any chance of a photo?

 

Any chance of a pic and a more in-depth history to include medical Hx and social Hx?

Thanks

Bill

 

Erythema is a spidery appearance and you are thinking a spider bite may be the etiology. I don't know sounds like a fascination with spiders. CBC might be in order and pictures and PMH would be valuable.

 

An update on this case. Sorry about delay, holiday has brought on a go slow period. The day after her ultrasound on the weekend the foot was extremely painful and more inflammed so she went to hospital where they diagnosed a furuncle. They lanced the area and drained excessive fluid and the patient is now pain free. I have never seen one in this position on the foot before nor a furuncle without a head or visible lumping over the area and i will be interested in seeing if any recurs. A great learning experience in all! :)