Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

dorsal foot rash extending to the mid tibia

Discussion in 'General Issues and Discussion Forum' started by rockyd, Apr 30, 2012.

  1. rockyd

    rockyd Member

    Members do not see these Ads. Sign Up.
    i seen a patient yesterday with a red/purple rash on the dorsum of both feet extending up to the mid tibia predominantly on the medial side the rsah doesnt extened to the toes and is not itching flaky or suggestive of contact dermatitis or eczema or psoariasis.

    the rash? is blancable on pressure and the capillary refill time is in excess of 10 seconds both on the rash and nrmal skin, the limbs are both cold and patient complains that the pain gets worse when she is in the shower and can not tolerate a hot shower, she also commented that she gets cramps. Foot pulses unpalpable. she has had the rash for 2 years now. also complains of cramps after walking. Also pins and needles.

    there is a family history mother has MS, (one of the symptoms of MS is Intolerance to heat). the girl is only 14 years old.

    any ideas on diagnosis differential or otherwise will be greatly appreciated. i have written to the GP for refferal dont know whether to suggest vascular or neurological.

    i have considered cushings syndrome due to the hyperpigmentation, but doesnt have the striae markings, systemic sclerosis, or PVD. currently taking no medications and no medical history.
  2. blinda

    blinda MVP

    From your description, I would plump for vascular, but difficult to advise without a pic.
  3. drsarbes

    drsarbes Well-Known Member


    Case report:
    Age, Sex, chief complaint, chronicity, past history, comorbidities.
    objective findings, in this case, the rash.

    Also: "I saw a patient...."

  4. blinda

    blinda MVP

    Indeed. See here; Presenting patients for clinical advice
  5. DTT

    DTT Well-Known Member

    Sure she is not diabetic??
    The symptoms you have stated would fit with Neurovascular insufficiency, Neuropathy, intermittant claudication?

    But as has been said, without some pictures and a more detailed case history it is difficult to give a firm opinion
  6. davidh

    davidh Podiatry Arena Veteran

    Since we're being picky, referral is not spelt refferal either, and blancable is not a word, although we know what you mean.
    I see unpalpable from time to time in podiatry casenotes. I don't like it - it isn't a word either as far as I know. Not palpable is more correct, and would be more easily recognised by GPs.

    Small things in themselves, but they all add up to an impression, both of you and podiatry generally, hence the importance.

    Interesting case presentation though. Well done for taking the time to post it.
  7. rockyd

    rockyd Member

    thanks people for the heads up regarding presenting a case just tried to cram the essentials in.

    I'll see if can get a picture or video of the cap refill time.

    i was leaning towards heamosiderosis but wasnt the classic brown colour and pt commented that the legs dont swell (possible venous insufficency) and given the family history of MS and intolerance to warmth.

    for the blanchable could have put erythematous. and the unpalpable i did think whether not palpable would be better.
  8. drsarbes

    drsarbes Well-Known Member


    Stasis hyperpigmentation will start out as stasis dermatitis. The hemosiderin deposits come later. The location you described is classic. On magnification you may find depression (pre ulcer) areas overlying the deep perforators.

  9. rockyd

    rockyd Member

    Cheers thanks for the feedback much appreciated

    and found out more re stasis dermatitis
  10. David Smith

    David Smith Well-Known Member

    Lichen planus?
  11. blinda

    blinda MVP

    Lemon curry?

    Rocky, Be good to see the pic....;)
  12. mburton

    mburton Active Member

    I sometimes wish we had a 'like' button as on Facebook as often the replies make me LOL!
  13. David Smith

    David Smith Well-Known Member

    <iframe width="480" height="360" src="http://www.youtube.com/embed/qKhit2nsoq4" frameborder="0" allowfullscreen></iframe>


Share This Page