Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
i seen a patient yesterday with a red/purple rash on the dorsum of both feet extending up to the mid tibia predominantly on the medial side the rsah doesnt extened to the toes and is not itching flaky or suggestive of contact dermatitis or eczema or psoariasis.
the rash? is blancable on pressure and the capillary refill time is in excess of 10 seconds both on the rash and nrmal skin, the limbs are both cold and patient complains that the pain gets worse when she is in the shower and can not tolerate a hot shower, she also commented that she gets cramps. Foot pulses unpalpable. she has had the rash for 2 years now. also complains of cramps after walking. Also pins and needles.
there is a family history mother has MS, (one of the symptoms of MS is Intolerance to heat). the girl is only 14 years old.
any ideas on diagnosis differential or otherwise will be greatly appreciated. i have written to the GP for refferal dont know whether to suggest vascular or neurological.
i have considered cushings syndrome due to the hyperpigmentation, but doesnt have the striae markings, systemic sclerosis, or PVD. currently taking no medications and no medical history.
i seen a patient yesterday with a red/purple rash on the dorsum of both feet extending up to the mid tibia predominantly on the medial side the rsah doesnt extened to the toes and is not itching flaky or suggestive of contact dermatitis or eczema or psoariasis.
the rash? is blancable on pressure and the capillary refill time is in excess of 10 seconds both on the rash and nrmal skin, the limbs are both cold and patient complains that the pain gets worse when she is in the shower and can not tolerate a hot shower, she also commented that she gets cramps. Foot pulses unpalpable. she has had the rash for 2 years now. also complains of cramps after walking. Also pins and needles.
there is a family history mother has MS, (one of the symptoms of MS is Intolerance to heat). the girl is only 14 years old.
any ideas on diagnosis differential or otherwise will be greatly appreciated. i have written to the GP for refferal dont know whether to suggest vascular or neurological.
i have considered cushings syndrome due to the hyperpigmentation, but doesnt have the striae markings, systemic sclerosis, or PVD. currently taking no medications and no medical history.
From your description, I would plump for vascular, but difficult to advise without a pic.
Case report:
Age, Sex, chief complaint, chronicity, past history, comorbidities.
objective findings, in this case, the rash.
Also: "I saw a patient...."
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
i seen a patient yesterday with a red/purple rash on the dorsum of both feet extending up to the mid tibia predominantly on the medial side the rsah doesnt extened to the toes and is not itching flaky or suggestive of contact dermatitis or eczema or psoariasis.
the rash? is blancable on pressure and the capillary refill time is in excess of 10 seconds both on the rash and nrmal skin, the limbs are both cold and patient complains that the pain gets worse when she is in the shower and can not tolerate a hot shower, she also commented that she gets cramps. Foot pulses unpalpable. she has had the rash for 2 years now. also complains of cramps after walking. Also pins and needles.
there is a family history mother has MS, (one of the symptoms of MS is Intolerance to heat). the girl is only 14 years old.
any ideas on diagnosis differential or otherwise will be greatly appreciated. i have written to the GP for refferal dont know whether to suggest vascular or neurological.
i have considered cushings syndrome due to the hyperpigmentation, but doesnt have the striae markings, systemic sclerosis, or PVD. currently taking no medications and no medical history.
Sure she is not diabetic??
The symptoms you have stated would fit with Neurovascular insufficiency, Neuropathy, intermittant claudication?
But as has been said, without some pictures and a more detailed case history it is difficult to give a firm opinion
cheers
Derek
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
Since we're being picky, referral is not spelt refferal either, and blancable is not a word, although we know what you mean.
I see unpalpable from time to time in podiatry casenotes. I don't like it - it isn't a word either as far as I know. Not palpable is more correct, and would be more easily recognised by GPs.
Small things in themselves, but they all add up to an impression, both of you and podiatry generally, hence the importance.
Interesting case presentation though. Well done for taking the time to post it.
thanks people for the heads up regarding presenting a case just tried to cram the essentials in.
I'll see if can get a picture or video of the cap refill time.
i was leaning towards heamosiderosis but wasnt the classic brown colour and pt commented that the legs dont swell (possible venous insufficency) and given the family history of MS and intolerance to warmth.
for the blanchable could have put erythematous. and the unpalpable i did think whether not palpable would be better.
The Following User Says Thank You to rockyd For This Useful Post:
Stasis hyperpigmentation will start out as stasis dermatitis. The hemosiderin deposits come later. The location you described is classic. On magnification you may find depression (pre ulcer) areas overlying the deep perforators.
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
dorsal foot rash extending to the mid tibia
Re: dorsal foot rash extending to the mid tibia
Linear Mode
