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?
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The attached photo was taken with the patient's iphone as my camera didn't take a brilliant snap.
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