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Unusual, spontaneous "bruising" in 50 year old female patient

Discussion in 'General Issues and Discussion Forum' started by Sarah-Jane, Jul 5, 2010.

  1. Sarah-Jane

    Sarah-Jane Member

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    Hi all

    Just wondering if anyone has any idea about this problem. I saw this 50 year old female patient a few weeks ago, took some pictures of her foot, hope you can see them in this post.

    She has attended our clinic over the past few years and this problem has occured recently but it has never been seen by a doctor as it resolves within a few days. She managed to get an appointment with me the day after it occurred so this is the first time both myself and my colleague have seen it.

    c/o "bruising", dicomfort and swelling on foot, has happened a few times over the last 6 months. Minimal pain, happens spontaneously and there is never any trauma involved, can be either foot and usually disappears within 3 or 4 days

    o/e apparent bruising/discolouration over right 5th plantar, lateral and dorsal MPJ and extending distally into the toe.
    Some pain on compression of the area, also a positive Tinels sign (could feel tingling and some pain moving proximally into her leg with tuning fork application)

    States that this was a mild case and the bruising is usually more extensive, moving proximally along the 5th met

    It does not occur elsewhere and is located generally over the lateral aspects of either foot

    Pedal pulses were biphasic although I did find a monophasic pulse when I moved the doppler slightly distal to dorsal pedis. She has a slow capillary refill and says her feet are usually cold. Arterial insufficiency seems to be a factor but the cause of the bruising is not apparent.

    It is unusual as it occurs and then disappears so quickly without any sort of trauma to the area....No significant family or medical history. She is a police officer and now has mainly a desk job.

    Any thoughts or ideas would be appreciated.


  2. drsarbes

    drsarbes Well-Known Member

    Hi Sarah-Jane:

    I do not see the pictures.

    In any event, there is quite a difference between "bruising" and inflammation. As I'm sure you know, true ecchymosis (i.e. a bruise) is blood leaving the blood vessels and entering the surrounding tissues. This does not subside very quickly since the body needs to resorb this blood.

    Dilated vessels, on the other-hand, will tend to diminish quickly if the underlying stimuli is removed.

    I would suggest a local inflammatory response of some sort, perhaps an old cold injury or local acute arthritic flare-up just to name two possibilities.

  3. Peter

    Peter Well-Known Member

    Hi Sarah-Jane

    I had 2 similar cases a few years back when I worked in N.ewton Aycliffe. The first case was seemingly Dx as a thrombocyte disorder. However his symptoms were very dramatic, and the pain was such he needed hospitalisation.

    Sorry if too vague,

  4. Sarah-Jane

    Sarah-Jane Member

    I'll try the pictures again....They're probably really big

    Attached Files:

  5. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    Perniosis ? Looks like an extensive, somewhat atypical chilblain - erythema pernio. The past winter here in Ireland was unusually cold for an extended time and everyday it seemed another chilblain presented.
  6. Lizzy1so

    Lizzy1so Active Member

    I agree, looks like perniosis, any history of raynauds?
  7. robert bijak

    robert bijak Banned

    Way too little history and physical and laboratory information. Poor presentation of a possible systemic condition robert bijak,dpm
  8. Sarah-Jane

    Sarah-Jane Member

    Hi Steve, Peter, Mr. Kerans and Edward

    Thanks for your thoughts on this. No history of Raynauds as far as I know. I realise that using the term "bruising" may not have been accurate, thanks for pointing that out. I have asked her family doctor and also a vascular surgeon to investigate further. I am unsure about the possibility of perniosis; I have talked to my colleague about this, he has worked here in Saskatchewan for the past 30 years and has very rarely seen perniosis simply because of the difference in climate. We have extremely harsh winters here, 40 below and it is an extremely 'dry' cold compared to say the UK. Also, this has flared up a few times over the past couple of months and it has been very warm here, 20 degrees plus. Thanks again for your replies.


    I am wondering why it says ‘banned’ under your name. I am a recent graduate and I cannot emphasise how useful I find this forum for sharing and asking for advice on certain problems. I realise that I don’t know everything and that is why I posted this problem for discussion. I’m sorry that you find my presentation of this to be poor but I would rather have some advice on how better to present it rather that a one lined insult.

  9. Sarah_Natali

    Sarah_Natali Member

    Good on ya Sarah -Jane I certainly wouldn't have done anymore than you in your assesment. Probably the Robert guy is an American who doesn't remember that elsewhere in the world we don't have to do surgury etc to be a pod. Glad the rest of the DPMs are more helpful.

    I had a lady with charcot -marie -tooth whose feet and legs sometimes went like that they did it every so often and caused her no bother - i just left it and told her to montitor it and we would investigate further if it caused pain or issue.

    I will be interested to see hear what you discover. x
  10. Sarah-Jane

    Sarah-Jane Member

    Thanks for that Sarah, interesting about the CMT.
    It might be a while before I hear anything about this case but I'll let you know

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