Foot Ulcers
A 31-year-old man from northern Ontario had acute
swelling, purpura and pain in his left lateral forefoot region, which
increased progressively over 10 weeks until he became bedridden. A
clinical diagnosis of gout was made, but the pain did not improve with
NSAIDs. One month later, a small pustule developed that progressed to an
ulcer with purulent drainage. On presentation 1 month later, his left
foot was swollen, and the lateral forefoot was exquisitely tender to
palpation. A 2-cm ulcer, which probed to bone, was present on the
lateral aspect of the foot (Fig. 1). The patient was afebrile, and
findings on general medical and pulmonary examinations were
unremarkable. A plain radiograph of the foot revealed dystrophic
calcification in the soft tissues, with osteopenia and periosteal
reaction along the fifth metatarsal bone consistent with active
osteomyelitis (Fig. 2). The chest radiograph appeared normal.
