Here is an interesting case study for your review and comment. 72 year old African American female presented to my clinic recently on referral for a 'sore' on the bottom of her right heel. She states that the lesion has been present for over 1 month and is painful. The patient also complains of some bleeding from the area upon weight bearing. She vaguely recalls stepping on some construction debris about a month ago while barefoot at home, but is a poor historian and you suspect some level of dementia. She had no prior treatment to the area other than use of dry dressings at home. Past medical history includes hypertension and she is currently taking Inderal and Dyazide. NKDA and no past surgical history.

The DP and PT pulses are palpable and neurological examination is unremarkable. Muscle strength is 4/5 and there is moderate diffuse edema to the right foot and ankle. The plantar heel lesion is hemorrhagic with pain upon palpation and bleeds easily. The margins do not appear to be adherent to the surrounding skin edge and there is no erythema or purlence noted. The area of concern measures 1.6 x 1.0 cm and there is significant guarding upon your examination today. X-rays are unremarkable. See clinical photo below:

Email me your thoughts on this and I will publish the comments and outcome of the case next week.