Inflamed foot sore

[ttkk]

My wife has a condition that she has been doctoring now for 9 weeks.  We can't get into a dermatologist for several weeks, so we were hoping for some guidance from you on what her condition might be and how to treat it in the interim to lessen the pain.  On 12/27/01, while sitting at her desk, she felt a sudden pain on her foot.  The pain developed all at once, nothing preceded it.  A slightly raised, perfectly round spot about the size of a dime developed at the site of the pain.  It is located over her big toe joint (1st metatarsal and proximal flange).  It was very tender to the touch, but was soft with no head.  After a few weeks, she went to her physician who took x-rays and a blood test to rule out a fracture or gout.  Both tests came back negative.  Not knowing what it was, he referred her to a podiatrist who also took x-rays and didn't see anything abnormal, but commented that it was a soft tissue sore and might be related to scar tissue from bunion surgery 20 years ago.  She injected cortisone to break up the mass.  After the first injection of cortisone, it felt better for a few hours but the pain returned as before.  A week later, another injection and no pain relief.  The podiatrist then recommended ultrasound therapy.  After 3 ultrasound treatments, a dark red/purple spot circle developed around the original spot and the skin peeled and an open wound developed in the center of the spot.  The area
around the spot became red and inflamed but only the spot was painful.  She then went to another podiatrist who said the cortisone may have aggravated the sore and recommended not letting anything touch the spot for 2 weeks.  It's been over two weeks now and no improvement either in appearance or pain.  She has no stiffness or pain in any joints, only the sore itself.  The size of the original sore has never changed, and has always been a perfectly round shape.  She has no other sores anywhere and has never had this condition before.  We would appreciate your thoughtful analysis and any insight or advice you may have regarding what this sore could be and how we might treat it before we are able to see a dermatologist.  She is very distraught as it has affected greatly her physical activities and it's been so long.. Thank you so much!

[Alan Rockoff, MD]

I'm afraid I have little insight into this problem.  Your careful description suggests something joint- or subcutaneous-related rather than a skin problem.  The initial evaluation to look for arthritis or gout seems apt, though of course the tests were negative.

I think that perhaps seeing a rheumatologist or orthopedist (or even another podiatrist) might be more productive than a dermatologist.

Sorry I can't be more helpful.

Best.

Dr. Rockoff

[aleta30]

A related discussion, why is the bottom of my feet burning hot? was started.