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I have been seeing this client for several months and he presents with unusual lesions on his left calcaneal area. The lesions are also present on both legs however they are not as severe as the ones on the calc. I have attached photos pre and post debridement.
As you can see it looks like HK however when you debride the area there is a marked periphery that appears to be HK going into the foot (sorry have trouble describing it).
Things to note:
The client has had them for close to a decade.
The lesion never changes size
There is pain on direct compression of the area pre and post debridement
He has not treated it as both his GP and dermatologist have turned him away as they’ve “never come across this before”.

I think it looks like a psoriatic plaque however I’m sure a GP and/or a dermatologist would have diagnosed this. Any thoughts? Help with this case would be GREATLY appreciated.

 

Great pictures. No great ideas on what it might be, although i did initially think it might be residual scarring from Vpedis, looking at the shapes and location. Also any fungal or parasitic history?

 

Although the OP stated that there were similar plaques on the legs...

I would be interested to see the lesions on the legs

 

Why not take a biopsy of the lesion and send it for analysis?

 

X5-452

I have a couple of patients with identical lesions and they are psoriatic plaques. Unlike your patient's, they are not painful so I tend to leave alone. I am interested to see that you debride but say they are painful both before and after debriedment, therefore is it worth debriding? Do you find it easy to get a haem when you are debriding?

Cornmerchant

 

X5-452,
I was also wondering about the efficacy of debridement, as it doesn't seem to relieve the symptoms.
I wonder if offloading the lesion would be more effective approach?

regards
CF

 

Stab in the dark...ringworm??

Has anyone taken a sample for culture?

What is the patients social history?

 

Cornmerchant - Debridement provides him with some relief as the amount of pain before is around a 7/10 but after it is a 1/10. I think the pain is just the tenderness from post debridement as he is used to the area being hard.

Catfoot - I applied some swanfoam inside his shoe and he has had great relief.

Toughspiders - I thought that too but I didn't think ringworm had the callousy appearance and I thought the area would be more red and inflammed if it was ringworm.

Also F.Y.I photos were taken with an iPhone 4.

 

And ringworm itches like bilio

 

Hi All,

From the post debridement pic the oval ring looks much like scar tissue, which on a weight bearing site such as this, would produce callus. This could explain the static appearance of the lesion, ie `The lesion never changes size`. But then again, the pt would recall a previous lesion that had been treated with electrocautery, electrosurger, acids, cryo or anything else that could cause scarring :confused:

How old is the pt? Have you considered granuloma annulare? I also once saw a similar ring of HK on resolved pityriasis lesions, but they were much smaller and rash like on the legs only.

Would be interested in the culture result.

Cheers,
Bel

 

Hi,

Can you give any information with regard to the following:

Is patient's skin generally dry? Are the lower limbs dry? Skin flaky (shins, for example)? Scaly? Does the patient have particularly linear palms (many more lines than -say - you)?

I've got an idea kicking around in what passes as my brain .... your answers may help it along.

cheers, footinmouth

 

Does this Pt have diabetes?

 

No the client doesn't have diabetes

 

Hi

Am still curious, so is patient's skin generally dry? Are the lower limbs dry? Skin flaky (shins, for example)? Scaly? Does the patient have particularly linear palms (many more lines than -say - you)?
Also amid any general dryness etc., does patient have any small similar lesions (although may not be 'flattened') anywhere else on body?

cheers
footinmouth

 

Hi
Maybe a dermatology opinion may be useful. Has he ever been referred ?
Regards
Deborah

 

looklike a scar postquirurgical

 

That`s what I thought...


http://www.youtube.com/watch?v=TGObF2q63Ew

:cool:

 

Many thanks blinda, I do believe that's the first RHCP reference I have seen on podiatry arena!!

Are they involved in any other reasearch??:good:

For my 2 cents worth while posting, I concur it most certainly looks as though it is long standing scar tissue...