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admin 07.06.2015

Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics. I initially thought he had sustained some superficial nerve damage due to the compression from the elastic stockings and hoped this would diminish once he started rehab and physiotherapy, but in recent days he has developed what appears to be a fungal infection with pustules and vesicles on the right foot around the affected area (see photograph). Given the clinical presentation I am now considering whether he has a herpes zoster infection as his symptoms are consistent with postherpetic neuralgia and a zoster skin rash. Can a herpes zoster infection develop symptoms in the foot - with one foot being more affected than the other - and is this a common manifestation following major surgery or just coincidental? If he first noticed the pain immediately after recovering from anesthesia, my first thought is a nerve compression from improper positioning on the OR table.
Looks like a sweat rash, Mark (similar to nappy rash) and you chaps have had pretty hot weather of late.
I've aslo treated a few rashes like that as Tinea Pedis and got results (topical lamisil cream or whatever you prefer). A very interesting 'case', as a newish private practitioner do you find this situation difficult, no longer having the luxury of intra NHS referral? Syphilis is an infection which comes in 3 stages and caused by bacteria known as treponema pallidum. Chlamydia is a sexually transmitted disease caused by bacterium called chlamydia trachomatis. Genital warts caused by some types of HPV (human papillomavirus) look like flesh-coloured or white smooth tiny bumps.


Genital warts are easily mistaken for pearly penile papules which are tiny white or flesh-coloured bumps that circle the edge of the penis. You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. He described the pain as similar to a nettle rash - more profound on light touch and now extends over the 2nd MTPJ plantar area. Also I think if compression syndrome was a factor it would be due to the elastic stockings rather that OR trauma, especially with bypass surgery. Paraestheisa around the hallux (usually medial side) can be due to impingement on the saphenous nerve where the end of the nerve serves the great toe.
It could be that the rash and the neuralgia are unrelated and that the symptoms are simply a result of nerve compression with the post operative stockings, but I would've hoped we'd see some improvement, especially now that he is attending rehab and physio.
I've seldom (if ever) seen it at the same time as the type of rash in your pic so maybe the rash isn't connected.
I've had him on topical lamisil for five days without any improvement and will try him on dermovate instead.
The chancre can appear as early as the 9th day after infection has happened or as late as 3 months. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. He was fitted post operatively with elasticated stockings as a precaution against DVT, however he complained that they were too tight and they were changed to a larger size after 6 days, which he wore for 8 weeks thereafter.


In recent weeks he also reports similar paresis on his left foot in the same area, but less intensive. Craig - thank you for the link and will bear CCE in mind - although for the patient's sake I hope this proves otherwise.
I find it peculiar that the symproms started immediately post-op - if related it could be OR trauma, localised trauma from elasticated stockings or, as Craig suggests, CE from embolisation during his CABG surgery.
Sometimes it happens after using synthetic fibers such as the ones used on the stockings manufacturing. Ulcers are known to disappear without treatment, but dont be fooled that is the end of that.
He has arranged an appointment with his cardiologist in two weeks so I'll report back what he suggests. Anyway, it is curious the limited extension although we do not know if the lesion was larger or not.
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