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Hi all,
I've been seeing a patient who has presented with multiple areas of extravasation with overlying callus. I had tried debriding the areas and using various orthotics and padding to reduce the intermittent pressure on those areas- however, at follow up appointments the areas of extravasation and callus were in a different place!
Any thoughts or ideas would be greatly appriciated!!

 

Hi khc10,
I have seen this manifestation on overweight patients. May I ask if your patient is adiposially gifted?

CF

 

Hi kch10

It is difficult to offer much help without a few more details about the patients medical history. I have seen this mainly in diabetic patients as an early warning sign of predisposition to breakdown and ulceration. I have also seen it in rheumatoid patients.
What does seem strange is that it moves to different places when you offload with padding/orthotics.

Have you more details?

Regards
CM

 

Its not that strange - with orthotics or padding you are reducing the stress on one area, but that stress does not disappear, it gets moved to other tissue.

So maybe this patient has systemic condition which as you say they have a predisposition to breakdown - now you change the forces acting on the foot with a orthotic or pad. So the effected area gets less stress, but now others areas get more and then breakdown.

Your chasing your tail.

So maybe back to the Dr for blood tests for systemic conditions that may cause skin to breakdown

my 2 cents

 

We obviously lack enough background information on this, but if padding is being used to offload high pressure areas and then produces high pressure in other areas, in my book that pad is faulty.The point of deflecting pressure is to diffuse it over larger areas thus reducing the risk of breakdown.

It would be helpful to see some pictures kch10.

Cm.

 

Thanks for your quick replies everyone!
The patient in question is indeed obese, but has no known medical conditions. When the areas of callus with extravasation have been debrided down the skin beneath is in good condition.
However, I think the idea of asking the GP for blood tests is a good idea and most likely what I will try next.
Also, its a fair point that the padding may be incorrect- i'll have to put some serious thought into my next move if i choose to try padding again :)

Thanks everyone!