A 69 y/o, 150 kg (medical practitioner) has been treated at the ambulatory wound clinic for the last 12/12 for lymphoedema compression bandaging. She also is on high dosage cortisone for rheumatoid arthritis.
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She had a 1/12 hospital stay bed-bound for pneumonia 4/12 ago.
The pain, on plantar surface of heel initially, can continue through the night.
On walking, the most painful time is when she lifts her foot! Otherwise the 'throbbing' pain, in her ankle/foot can keep her up most nights.
A pale coloured lesion was noticed 2/12 ago and has grown more prominent and hopefully i'll attach it.
The patient has seen a rheumatic specialist, a vascular surgeon (who attempted to lance his diagnosed abscess with no success, he now thinks it's 'fatty pad' related), a sports medicine practitioner, several podiatrists to very little avail. The lesion and surrounding plantar rearfoot surface is too painful to touch.
The photo doesn't make the pale lesion, at the distal end of the exfoliation, as white at it appears to the eye.
The feet are extremely swollen, she wears a post op wrap-around velcro boot, and he contralateral heel is beginning to get 'very sore', confirmed with palpation of the plantar medial tubercle region.
Differential dx, tx, any advice appreciated, mark
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