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Hi All

I have been treating a client for a couple of weeks for a painful lesion in the middle of her heel L.

She had stated that it had been there for a period of 2 months with increasing discomfort and when asked if she had been away on holiday or swimming or had changed shoes recently her answer was no. She had attempted to alleviate it with some duofilm as prescribed by her pharmacist with no improvement.

O/E small lesion evident with extreme tenderness on both direct palpation and squeezing. Defined margins of lesion evident with no punctate haemorrhages. Pain radiates from lesion to the lateral edge of the foot decreasing as the distance increases from the lesion.

Debridement is extremely painful and the lesion is vascular. I have treated it with salycylic acid over the last week with a significant improvement in the depth of the lesion, however it is still incredibly painful. She is going to have an X-ray to eliminate the presence of a foreign body within the tissue but other than this differential diagnosis I am at a bit of a loss.

Any thoughts would be greatly appreciated.

Regards

A

Andrea - can you post a digital photo?

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I'll be happy to...I just will have to take one next week

Hi Andrea,

In a case such as this the best possible course is to either a punch or incisional biospsy of the lesion in toto.You send it in to pathology for a confirming diagnosis.While at the same time removing the lesion.
My bet is that it is probably a compression neuroma of some type.They tend to be very vascular in nature with exquisite pain.

Regards,
rick