Foot diagnosis

Stress or fatigue fractures are very painful. Most often symptoms occur after athletic activity or physical exertion. Gradually pain worsens and becomes more constant. Stress fractures do not show up on standard x-rays. A bone scan maybe used to confirm the diagnosis. Stress fractures usually occur in the weight-bearing bones of the lower leg and foot. Stress fractures of the tibia account for half of all stress fractures, resulting mostly from athletic activity. These stress fractures are often mistaken for shin splints. In addition to the tibia, the fibula and other small bones of the foot are prone to stress fractures. 

Thus, the presence of uric acid crystals in joints triggers a vicious cycle, resulting in an extremely painful inflammation. A typical localization of acute gouty arthritis is the first metatarsal joint of the foot (podagra). The diagnosis of acute gouty arthritis is confirmed by the detection of urate crystals in the joint or tophus. 

Venography (also known as phlebography) is the gold standard for the diagnosis of DVT. However, it is an invasive test that involves injection of radiopaque contrast dye into a foot vein. It is expensive and can cause anaphylaxis and nephrotoxicity. 

Not all diabetic foot ulcers are infected. However, infection is often difficult to detect when perfusion and the inflammatory response are limited in the diabetic patient. The common signs and symptoms (i.e., pain, erythema, and edema) of infection may be absent.32 Still, the diagnosis of diabetic foot infection depends mostly on clinical evaluation. 

Lipsky BA, Berendt AR, Deery G, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004 39 885-910. Livesley NJ, Chow AW. Pressure ulcers in elderly individuals. Clin Infect Dis 2002 35 1390-1396. 

Suggested Alternatives for Differential Diagnosis Foot-and-mouth disease, vesicular stomatitis, peste des petits ruminants, photosensitisation, nasal botfly infestation, pneumonia, akabane infection, epizootic hemorrhagic disease of deer, contagious ecthyma, polyarthritis, footrot, foot abscesses, plant poisonings, and coenurosis. 

Suggested Alternatives for Differential Diagnosis Rinderpest, infectious bovine rhino-tracheitis, bovine herpes mammillitis, malignant catarrhal fever, Peste des petits ruminants, vesicular stomatitis, bluetongue, bovine viral diarrhea, and foot rot in cattle, vesicular exanthema of swine, swine vesicular disease, and foreign bodies or trauma. 

Suggested Alternatives for Differential Diagnosis Bovine viral diarrhea/mucosal disease, rinderpest, bluetongue, foot and mouth disease, vesicular stomatitis, pneumonic pas-teurellosis, photosensitive dermatitis, infectious bovine rhinotracheitis, theileriosis, rabies, and the tick-borne encephalitides. 

Suggested Alternatives for Differential Diagnosis Boutonneuse fever, chickenpox, scrub typhus, hand-foot-and-mouth disease, meningitis. 

Lees, A. (1995). Diagnosis and Control of Foot Rot Pathogens of Wheat. Open University, PhD thesis. Buckinghamshire, UK. 

Gentry LO. Diagnosis and management of the diabetic foot ulcer. J Antimicrob Chemother 1993 32(suppl A) 77-89. 

The majority of casualties were assessed at St. Luke s International Hospital, which is located within 3 km of five of the affected subway stations, although a further 568 patients were assessed at five other hospitals (Kato and Hamanaka, 1996 Masuda et al, 1995 Nozaki et al, 1995 Suzuki et al, 1995 Yokoyama et al, 1995,1996). Doctors at St Luke s were notified at 08 16 hours of an explosion and fire at a nearby subway system (Matsui et al, 1996 Okumura et al, 1996) and, twelve minutes later, the first victims arrived on foot at the emergency department. A casualty in cardiopulmonary arrest was brought in by private car at 08 43 hours. In all, 640 casualties were assessed at St Luke s Hospital on 20 March 1995, with the Chapel being used as the main treatment area (Okumura et al, 1996). Initially (at 09 12 hours), the Fire Department identified acetonitrile as the suspected agent. However, medical staff discounted this diagnosis as all casualties had marked miosis and atropine was therefore administered pralidoxime iodide was first given at 10 00 hours. Miosis appeared to be a more sensitive early indicator of exposure than erythrocyte acetylcholinesterase activity (Nozaki et al, 1997). 

Wagner FW. The dysvascular foot A system for diagnosis and treatment. Foot Ankle 1981 2 64-122. 

Sobel M, Geppert M, Olson E, et al. The dynamics of peroneus brevis tendon splits a proposed mechanism, technique of diagnosis, and classification of injury. Foot Ankle 1992 13(7) 413-22. 

Rupture of the superior peroneal retinaculum, which extends from the lateral aspect of the distal fibular to the calcaneus, may result in peroneal tendon subluxation. Sometimes there is an associated avulsion fracture of the lateral aspect of the distal fibula. Typically, the patient will complain of painful clicking of the ankle, particularly on dorsiflexion and eversion of the foot. The diagnosis is often obvious... 

Fig. 7. Allergic contact dermatitis to black rubber in a work boot. Note the hyperkeratotic scaling dermatitis most pronounced over the metatarsal area and tips of the toes. This pattern, together with sparing of the interdigital webs, the toe creases and the arch of the foot should suggest the diagnosis. Patch tests were positive to N-isopropyl-N -phenylparaphenylenediamine (IPPD) and black rubber mix. Reproduced with the permission of Donald V. Belsito, M.D., Division of Dermatology, University of Kansas Medical Center, Kansas City, KS...

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