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Leg ulceration – 10 cases

This quiz tests your diagnostic skills for leg ulceration.

For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.

Case 2

Painless ulceration on the sole of one foot.

Neuropathic ulceration

Minor trauma in a patient that has underlying diabetes mellitus, which has resulted in neuropathy and arteriolar ischaemia.

Diabetes accounts for 15-25% of leg ulcers, and for the majority of chronic foot ulcers. Symptoms of sensory neuropathy include pain, paraesthesia and anaesthesia. Signs include:

  • Warm, dry foot with palpable pulses
  • Reduced response to light touch and painful stimuli distally.
  • Loss of ankle jerk reflex

In response to pressure, the skin of the sole, toe or heel increases in thickness (callus) but with a minor injury breaks down and ulcerates. The most common sites are the soles, metatarsal head, great toe (bunion) or heel. These ulcers are frequently secondarily infected.

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