Question about unique foot condition

[Globetrvlr]

We were recently presented with a very unique case that has been unable to be figured out my both my professor and the rest of the class. A patient is having a condition that is causing them to have a tough time walking on his feet. After about 5 hours or so he will get a sudden rush of pain starting from the tips of his toes and it will shoot straight up his leg. He explained that it is much like an electrical shock and the pain is rated at a 10. Occasionally his toes will turn blue, the foot will swell and there is a burning sensation on the under part of his foot. He also has a few black scabs on his legs as well that have come up as a result. His skin is very splotchy on his legs and this is only occurring on the LEFT foot. He is 63 years old and we have visited a few doctors who have told him that it is not Morton's neuroma or TTS(Tarsal Tunnel Syndrome). Lupus has been ruled out as well. This has become a big issue and it affects him every day. He has worked in home remodeling for a long time so he is a very active person. CT Scans, nerve biopsies, blood work and numerous other tests have been done and all of them have not been able to pinpoint the problem. Although the leg scabs may be vasculitis (we are still checking on that) I feel as though they are related. Blood work and CT scans have not shown any type of clots so I am assuming that there is a cyst of some sort or some sort of inflammatory disease that is applying pressure to the nerves and restricting blood flow. Elevating the legs does help as well as rest but the pain will still occur once he becomes active again. Let me know what your thought are and if there is anything you might be able to tell me about this condition. We are all stumped at this point.

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[densmore22]

We were recently presented with a very unique case that has been unable to be figured out my both my professor and the rest of the class. A patient is having a condition that is causing them to have a tough time walking on his feet. After about 5 hours or so he will get a sudden rush of pain starting from the tips of his toes and it will shoot straight up his leg. He explained that it is much like an electrical shock and the pain is rated at a 10. Occasionally his toes will turn blue, the foot will swell and there is a burning sensation on the under part of his foot. He also has a few black scabs on his legs as well that have come up as a result. His skin is very splotchy on his legs and this is only occurring on the LEFT foot. He is 63 years old and we have visited a few doctors who have told him that it is not Morton's neuroma or TTS(Tarsal Tunnel Syndrome). Lupus has been ruled out as well. This has become a big issue and it affects him every day. He has worked in home remodeling for a long time so he is a very active person. CT Scans, nerve biopsies, blood work and numerous other tests have been done and all of them have not been able to pinpoint the problem. Although the leg scabs may be vasculitis (we are still checking on that) I feel as though they are related. Blood work and CT scans have not shown any type of clots so I am assuming that there is a cyst of some sort or some sort of inflammatory disease that is applying pressure to the nerves and restricting blood flow. Elevating the legs does help as well as rest but the pain will still occur once he becomes active again. Let me know what your thought are and if there is anything you might be able to tell me about this condition. We are all stumped at this point.

If all inflammatory markers are negative (and I would send him to a Rheumatologist to get thorough w/u and if no biopsy of the leg lesions have been done, they need to be), I have seen popliteal entrapment syndrome present similar to this. It's a VERY RARE syndrome, but could explain some of his issues. Would need a dynamic ultrasound pre and post symptom to see what exactly is going on, otherwise, who knows. Interesting case though.

 

[Porkchop22]

Rsd