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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)
Thanks,
Kara.

 

just add this one to the differential list:

scleroderma

 

Kara47,
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.

regards

Catfoot

 

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.