Contributed by Christine Dorvault, MD, Uma Rao, MD, John P. Anhalt, PhD, MD, Ellen Wald, MD and William A. Pasculle, Sc. D.
Published on line in October 1996
PATIENT HISTORY :
A fifty-two year old woman presented with the chief complaint of redness, pain, swelling of the lateral aspect of her left foot, and a draining wound between the fourth and fifth toes. Her past medical history was significant for surgery on her left foot two years ago to remove bone spurs between her fourth and fifth toes. Twelve months prior to presentation, the patient noticed some discomfort and mild inflammation between her toes which was treated with topical medications with apparent approvement. Two months prior to presentation, she developed intermittent swelling, erythema, and discomfort of the fifth toe. She was treated with ciprofloxacin twice (dosage and length of treatment unavailable) without improvement. An ulcer developed on her lateral left foot with associated erythema, swelling and tenderness. On physical examination, an ulcer on the lateral surface of the fifth toe surrounded by erythematous skin and a sinus tract between the fourth and fifth toes was noted (Images 01, 02, 03 and 04). Incision and drainage of the lesion was performed. Tissue was sent for cultures and surgical pathology.