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Can anybody offer any prelim. suggestions for a lady that I will be seeing in a couple of weeks. She described her problem to me over the phone and I would like to have some d/dx for when she comes in. Last couple of years she has had a lump on her middle right toe which sweels up and fills with "pus" (a white exudate). Unless she expels this it gets very sore. The lump is dorsally. This si all the info I know so far.
Thanks anyone
Lisa

 

Is this patient diabetic?If so,this sounds to me like diabetic bullae,which drains an aseptic fluid.If not it could be blisters related to shoegear or an ingrown nail w/paronychia.

 

Could also be a tophaceous gout. David M. Davidson, DPM

 

Dr.Davidson has a good point.Anyway,blood work and a complete H &P is the way to go.

 

If it is not a bullae and it is not gout it can be a ganglion. I just surgically resected a large 2.0 cm ganglion from the extensor tendon of the hallux after draining it 2x did not yield lasting results.

J. Morse, DPM
Wash DC

 

thanks

Thank you for your suggestions. I am seeing this lady tomorrow so your thoughts are sure to come in very handy.

Thanks again
Lisa

 

Hi,
thought I'd just update on the lump. The pt had popped the lump and said it did not look at all like a blister. When I saw it, it was red, but with no centre or head. Looked like there was some osteophyte below it. She's not diabetic. Very dorsiflexed digits so I made a simple felt dorsal pad to try to take the pressure off the area. She's very active and has developed this since upping her fitness regime on the treatdmill. I haven;t heard anything back yet.

Cheers
Lisa

 

I'd follow up for gout.