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Discussion in 'General Issues and Discussion Forum' started by Kara47, Feb 19, 2011.

  1. Kara47

    Kara47 Active Member

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    Hello All,
    Had a patient present the other day with a painless "sausage toe", soft tissue swelling on X ray was the only notable feature. She is mid fifties, has haemachromatosis. I have read that iron can accumulate in the joints and cause arthritis, but there is no pain or inflammation. Has anyone else come across this? the only other differential diagnoses I could come up with were:
    Psoriatic arthritis ( no psoriasis present)
    Gout ( no pain/ inflammation)
    Reiter's disease ( as above)
  2. charlie01

    charlie01 Active Member

    just add this one to the differential list:

  3. Catfoot

    Catfoot Well-Known Member

    A "sausage toe" is a reliable indicator of osteomyelitis in a diabetic patient, but you say that an x-ray has ruled that out.
    I have seen many of these types of toes over the years and they have been usually asymptomatic. The only problems I have seen is when the skin develops "folds" which can restrict hygiene or when they impinge on neighbouring toes.

    I think the haemachromatosis could be a "red herring".

    Scleroderma usually causes pain, stiffness and swelling and would affect other areas.

    Working on the "if it ain't broke don't fix it" principle I would be inclined just to monitor the situation. It could well be idiopathic.

    If you have a picture that might help.


  4. charlie01

    charlie01 Active Member

    A patient with osteomyelitis and diabetes is generally unwell and should have fever and most importantly uncontrolled high sugar level.

    Of course X-Ray can be used as a first line investigation.

    I would also add Chilblains to the diff. list.

    however it's better to let physicians to make the diagnosis and management plan.

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