Rapid-fire Lower Extremity Pathology!

May 28, 2011
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As we wind down the month during which time we’ve discussed some uncommon lower extremity pathologies, I thought this week we would take a rapid-fire approach. We will touch very briefly on several lower extremities pathologies and encourage you to comment or write in if you have questions regarding any of the areas presented. Let’s get started! Buerger’s Disease (BD): Young male patients with a history of cigarette smoke, who suffer from intermittent claudication (pain in their legs with activity) that limits the amount of activity they can perform, can often times be diagnosed with Peripheral Vascular Disease (PVD). A pathology we’ve talked about in the past, where flow of blood from the heart to the legs is limited secondary to narrowing of the blood vessels. However, Buerger’s Disease should be ruled out as the symptoms are the same as PVD, but the pathology is quite different. In BD, the blood vessels become inflamed, swollen and blocked at various levels by clots resulting in decreased blood flow. The risk factors include genetic predisposition (family history), chronic gum disease and cigarette smoking. Those patients with advanced disease must quit smoking or risk amputations as the disease progresses.

Haxthausen’s Disease (HD): This disease, often confused with dry skin and other skin conditions that produce thick, callus-like scales on the hands and feet is found in post-menopausal women. The condition is typically associated with arthritis, obesity and hypertension and is difficult to diagnose because of the numerous skin diseases in a Podiatrist’s repertoire and HD’s rarity. It has been documented that a link between HD and psycho-emotional conditions and metabolic disorders exists, however there are too few cases to predict this with any certainty. The skin lesions first appear on the soles of the feet and progress to the palms of the hands. Treatment consists of topical steroids to treat the itch and inflammation, along with heavy application of moisturizers. If left untreated, the itch can become so severe and the rash so progressed that sloughing of the skin and creation of painful fissures occurs. 

Trench Foot: This pathology has a very distinct clientele associated with it: individuals with trench warfare experience. It is also known as immersion foot and is so named as it occurs as a result of immersion of one’s foot in wet and cold environments for a prolonged time period. When the feet become wet and cold at the same time, the blood vessels constrict, decreasing blood flow to the affected areas and if not treated by removing wet socks and shoes while re-warming the feet, permanent damage to the nerves and blood vessels can occur. In the unlucky soldier, permanent damage results in chronic itching, pain and swelling of the feet with blotchy skin changes, scaling and a “heavy” feeling to the feet. Patients with the long-term sequelae of Trench Foot will require long-term care by a Podiatrist. 

Lobster Foot: Picture a lobster claw…Lobster Foot is a rare congenital (inherited) abnormality, present at birth where one or both feet are missing what are called the “three central rays.” What this means is that toes 2, 3 and 4 are missing, along with their corresponding long bones (metatarsals), responsible for connecting the toes to the middle portion of the foot. This absence leaves only the 1st and 5th toes and their corresponding metatarsals in place, creating the look of a lobster claw. Treatment of this pathology aims to restore function to a foot that would otherwise be non-functional and impossible to bear weight on. Each case is treated independently, but typically requires surgery where both bone and soft tissues are part of the solution. 

Macrodactyly: This is a rare, congenital abnormality that is not present at birth, but rather becomes more and more obvious as the patient ages. It is a form of “localized gigantism” where one digit becomes much larger than the others with growth. Each case is different and may or may not be associated with simultaneous enlargement of tendons, nerves and blood vessels in the affected digit. One thing that is common however is an increase in the amount of skin covering the digit, as it is a necessary part of accommodating the toes growth and often presents the greatest challenge in reducing the size of the digit. Numerous surgical procedures from size reduction and amputation have been attempted, but secondary to our unclear understanding of this pathologies etiology, recurrence is very common. 

Well, that concludes this weeks “Rapid-fire!” As a Podiatrist, the saying, “when you hear horse-hoofs, think horses, not zebra’s” applies, but every once in a while, a zebra might just be walking into the office. I hope you’ve enjoyed this month articles covering ‘Zebra-like’ (uncommon) pathologies! 

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