Inquiry Regarding Foot Lesions
Age: 41 Gender: Male Height: 6 feet Weight: 155 pounds Race: White Duration of symptoms: Over 3 months Affected area: Lateral aspect of the left forefoot Pre-existing medical conditions: None. Engaged in extensive biking and hiking, spending considerable time on my feet. Current medications: ACE inhibitors I have noticed a few small lesions on the outer side of my left forefoot. They tend to be sensitive when I walk or when pressure is applied. These lesions have persisted for at least a couple of months, and there’s no indication that they are enlarging or multiplying. The skin over the lesions has developed a thickened, calloused appearance, and they seem to have a shiny, hyperkeratotic quality without any organized growth structure—more so resembling a response to the underlying tissue. They feel like localized fibrous or dense masses. There is no sign of inflammation, red discoloration, or any discharge. I have had no incidents of injury. I suspect they might be fragments of splinters or glass embedded in the skin. Any insights on this matter would be greatly appreciated.
Answers (1)
3/19/2025, 11:40:45 AM
OpenHealth AI
Your symptoms suggest the presence of callous-like lesions on the lateral aspect of your left forefoot, which have been recurring for over three months. Given their appearance and lack of inflammation or discharge, it's possible these could be caused by chronic friction or pressure from your activities, especially considering your extensive biking and hiking.
Explanation:
The thickened, shiny, and hyperkeratotic quality of the lesions indicates that your skin is responding to repetitive stress or friction, which is common in active individuals. This can lead to a condition like plantar keratosis, or possibly warts, and under certain circumstances, might even suggest retained foreign material like tiny splinters or glass shards.
Next Steps:
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Self-Care: Begin by protecting the affected area:
- Use cushioned pads or well-fitting footwear to reduce pressure on the lesions while walking.
- Apply a moisturizing lotion daily to the lesions to help soften the thickened skin, which may promote healing.
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Observation: Monitor the lesions for any changes:
- Note if they change in size, color, or sensitivity over the next couple of weeks. If they worsen or you notice any new lesions, this indicates a need for further attention.
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Gentle Debridement: Consider gently filing the thickened skin:
- After soaking your foot in warm water, use a pumice stone or foot file to carefully reduce the thickness of the calloused area. Avoid aggressive filing to prevent irritation.
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Educate yourself on Footcare: Learn about appropriate footwear and foot hygiene, especially given your active lifestyle. This can help prevent further lesions:
- Seek footwear that provides good support and cushioning.
- Maintain foot hygiene by washing and drying your feet thoroughly, and regularly inspecting them for any changes.
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Assess Activities: Evaluate your activities:
- If possible, reduce high-impact activities temporarily to see if this relieves pressure on the lesions.
If after following these steps you do not notice any improvement after a few weeks, or if the lesions become painful or show signs of infection, it would be wise to seek a professional evaluation. This can provide further diagnosis and appropriate treatment options tailored to your specific condition.
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Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.