Dr. Anshul Varshney
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 33-year-old female with a history of erythema nodosum. I used to get outbreaks over my bilateral shins and ankles. The last bad outbreak was probably around seven to eight years ago. I woke up this morning with pain and swelling of the lateral parts of both feet around the cuboid bone. The strange thing was that it continued to hurt with radiating pain throughout the day. I made a podiatrist appointment. After x-rays and examination, he diagnosed me with peroneal tendonitis and gave me orthotic boots and ankle braces to wear. The doctor seemed confused by the swelling and the fact that this happened so acutely with no injury, increased activity, etc. However, it did not hurt me until I reach home. I am realizing that the pain is so familiar, like my nodules, which I used to get on my shins. I am just wondering if it could really be erythema nodosum on that part of my foot and especially being that it is occurring bilaterally at the same exact location on each foot. Is this possible? Thank you so much for your help with this matter.
Hi,
Welcome to icliniq.com.
We are here to help you. Reading your case summary and studying the attached report (attachment removed to protect patient identity); I would say that the favorable diagnosis in your case would be erythema nodosum (inflammation of fat cells under the skin). Characteristically, the lesions appear on the anterior legs but can be present anywhere. It can be bilateral or unilateral. I would advise you to go for the following investigations:
ESR (erythrocyte sedimentation rate).
Throat swab for streptococcal.
CRP (C-reactive protein).
In case these tests come out negative, then you should go ahead for ANA (antinuclear antibody) and skin biopsy to rule out vasculitis.
Thank you.
The Probable causes
Investigations to be done
Patient's Query
Hello doctor,
Thank you for your response. So, is it common for the bilateral location to be in the same spot on each foot?
Hi,
Welcome back to icliniq.com.
Yes, we frequently see the same picture. Actually, every disease in reality is not as classical as it is in the literature. Moreover, there are chances that investigations are required; if we feel that the picture is not classical. The common presentations are seen in cases having vasculitis. So, you need to be sure of it with the help of investigations. I suggest you go for the discussed investigations and let us be sure of the diagnosis. You must have been given treatment by your doctor. Can you mention the medicines given to you?
Thank you.
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Internal Medicine
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