PhotoQuiz: Footnotes in Differential Diagnosis

October 18, 2013

In some cases, the feet hold clues to systemic conditions in rheumatology. Can you use these images to get to the bottom of the condition that is affecting the entire patient?

Question 1:
A blue second toe was noted on the foot of a 77-year-old woman being treated for complications of dementia who had had aortic problems and atrial fibrillation. Manual separation emphasizes dissemination of irregular purple discoloration onto the sole just proximal to the blue toe. Prominent warty keratosis is seen on the second toe and keratinous debris on the third toe and in a “trench” just before the smaller toes separate.

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Question 2:
A “rocker bottom foot” deformity is shown. A noninfected neuropathic ulcer on the bottom of the midfoot resulted from increased pressure from ambulation. Increased hyperkeratotic skin around the ulcer was caused by walking.

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Question 3:
Dactylitis, or “sausage digit,” is seen in the toes of a child with juvenile idiopathic arthritis.

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ANSWER KEY:



Question 1. Answer: F

Question 2. Answer: C

Question 3. Answer: A