Ryan Fitzgerald, DPM
PRESENT RI Associate Editor
Hess Orthopedics &
Sports Medicine,
Harrisonburg, Virginia
|
|
Case Presentation:
Suspicious Soft Tissue Mass
HPI: The patient is a 70 y/o male who was referred by his primary care physician for a “bleeding wound” on the dorsum of his left foot. The patient states that he had a lump develop on his foot during the summer and that in July his PCP “burned it off.” The patient relates that the wound subsequently healed with a scab over the previous lesion site, and that approximately one month prior to his presentation in the office the scab fell off and this current lesion appeared underneath. He then returned to his PCP, who, in turn, referred the patient to the foot and ankle specialist. He denies a history of similar lesions on his foot or elsewhere on his body.
PMH: HTN, dyslipidemia, osteoarthritis
PSH: Gall bladder surgery, Wisdom tooth extraction, CTR (x2), R knee arthroscopy
FMH: Noncontributory
MEDS: Atenolol, Lipitor, multivitamin, calcium with Vitamin D
ALL: NKDA
SOCIAL: the patient relates to previous tobacco usage and states that he was 1PPD smoker, and that he stopped smoking approximately 10 years ago. He relates to social ETOH consumption, and denies drug use.
ROS: The patient denies any other complaints apart from the above complaint. He denies any recent history of fevers, chills, nausea, vomiting, or any other constitutional symptoms.
VS: BP: 132/82, HR: 72, RR: 18, Temp: 98.2
Imaging Studies: Plain film radiographs were obtained of the patients left foot, which demonstrate no fractures, dislocations, calcifications or other radiographic findings apart from generalized degenerative joint changes that are age appropriate.
PE: The patient is alert and oriented and in no apparent distress. He demonstrates palpable pedal pulses that are graded +2/4 at the dorsalis pedis and +1/4. On the dorsum of the left foot, the patient demonstrates a hyper-pigmented lesion that measures approximately 2cmx1.5cm, and is friable, and bleeds easily with abrasion (fig. 1 below).
|
| Figure 1: The patient demonstrates a large lesion on the dorsum of his left foot that is hyper-pigmented and demonstrates several smaller surrounding lesions that appear to radiate from the central aspect of the mass. The mass is tender, and bleeds easily. |
The mass appears freely movable in the skin tissues and is mildly painful to palpation (fig. 2 below). Sensation is grossly intact via 5.07 SMWF test to the distal distributions of the L4, L5, S1 nerve roots. Proprioception and vibratory sensation is also intact. Muscle strength is assessed and graded +5/5 in dorsiflexion, plantar flexion, inversion and eversion with no pain or crepitation noted on ankle of subtalar joint range of motion.
|
| Figure 2: The mass is tender, bleeds easily, and is in the location that the patient relates he and a previous “lump” removed approximately six months ago. Prior to that, he relates he had the “lump” for approximately a year. He denies having any other similar lesions elsewhere on his body. |
Considering the history and clinical exam presented, how would you proceed with this challenging case? Please reply to the current eTalk thread on this topic on PRESENT PODIATRY and we will present the conclusion of this case in a future RI.
 |
The Diabetic Charcot Foot: Principles and Management
by Robert G. Frykberg DPM, MPH, Editor |
| This text provides the reader with the most current information available on the pathogenesis, natural history, and management of the diabetic Charcot foot.
Many of the world's experts have come together to present their unique perspectives on this disorder. It is our hope that this work can become a valuable resource for those less familiar with the peculiarities of this often misunderstood complication of peripheral neuropathy. I am indebted to each author for the contribution of their time, efforts and expertise.
|
|
Get a steady stream of all the NEW PRESENT Podiatry
eLearning by becoming our Facebook Fan.
Effective eLearning and a Colleague Network await you. |
 |
|
