FOOT ULCERATION
Ask the Following Questions:
- Are there diminished or absent peripheral pulses? The finding of poor peripheral pulses would suggest that the lesion is secondary to ischemia from arteriosclerosis, Buerger's disease, diabetic arteriolar sclerosis, familial hyperlipidemia, and cryoproteinemia.
- Are there abnormalities on neurologic examination? The presence of good peripheral pulses should make one look for a neurologic explanation for the ulcer, and if there is diminished sensation to touch and pain in the periphery, peripheral neuropathy is very likely. Ulcers may also form in paraplegia of any cause, leprosy, and tabes dorsalis.
- Is there a history of diabetes? A history of diabetes makes the diagnosis of diabetic arteriolar sclerosis very likely. Remember, the pulses may be normal in this condition.
- Is there a positive smear or culture? The presence of good peripheral pulses should prompt one to do a smear and culture of material from the lesion, and if this is positive, then the diagnosis is made. We would consider, in addition to the normal bacteria, blastomycosis, sporotrichosis, maduromycosis, and syphilis.
DIAGNOSTIC WORKUP
Diminished pulses is a clear indication for Doppler ultrasound studies. Routine tests include a CBC, sedimentation rate, urinalysis, chemistry panel, VDRL test, and glucose tolerance test. An x-ray of the involved foot should be done to rule out osteomyelitis. A bone scan is even more sensitive to osteomyelitis and other disorders of the bone that may be causing the ulcer. A smear should be made of the ulcer material and a culture done also, not just for the common pathogens, but for AFB and fungi. A dark field preparation may be necessary. Skin testing for blastomycosis and other fungi should be done. A nerve conduction velocity study of the lower extremities will be helpful in differentiating neurologic causes. Femoral angiography may be valuable in determining the exact level of the lesion and whether it can be approached surgically.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
Other Book Chapters Related to Foot symptoms
Read excerpts from these other book chapters related to Foot symptoms:
Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
More About Causes of Foot symptoms
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