Leg Ulcers/Foot Pain

Question 0

Ulcers due to arterial insufficiency – usual location? Work up with what tests?

Answer 0

Tips of toes

Doppler studies followed by CT angio/MRI angio and surgical revascularization

Question 1

Diabetic ulcers – start because of? Fail to heal because of?

Answer 1

Neuropathy; microvascular disease

Question 2

Venus stasis ulcers – specific location? Factors that increase risk of development? Associated conditions? Treatment?

Answer 2

Medial malleolus

Chronic edema, induration, hyperpigmentation

Varicose veins and cellulitis

1. Physical support to keep things empty (support stockings, ACE bandages, umma boot)
2. Surgery – vein stripping, Endovascular ablation, grafting

Question 3

Marjolin ulcer? Typical predisposing conditions? Treatment?

Answer 3

Squamous cell carcinoma of the skin developing in chronic leg ulcer

1. Third degree burn that undergoes spontaneous healing
2. Chronic draining sinus secondary to osteomyelitis

Wide local excision and skin grafting

Question 4

Plantar fasciitis – Description of symptoms? Pain worse when? X-ray findings? Course? Surgery when?

Answer 4

Disabling sharp heel pain every time foot strikes ground

Pain worse in the mornings

Bony spur matching the location of the pain (spurs, however, are not cause a problem – asymptomatic people have similar spurs)

Spontaneous resolution usually within 12 months

No role for surgery

Question 5

Morton neuroma? Typical cause? Management?

Answer 5

Inflammation of the common digital nerve at the third interspace (between third and fourth toes)

Pointed, high-heeled shoes or cowboy boots

Analgesics and if needed, surgical excision

Question 6

Gout – crystals in joint? Treatment of acute attack? Treatment for chronic control?

Answer 6

Uric acid;

Indomethacin and colchicine

Allopurinol and probenicid