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A 75 year old white man was referred to the clinic for assessment of left foot pain. At the age of 16, while in India, he had contracted leprosy and subsequently had developed ulcers over the midtarsal area of his right foot, leading eventually to a right below knee amputation at the age of 44. He had also had amputation through the distal aspects of most of his fingers and had undergone removal of the toes of his left foot When seen in the clinic he had localised ulceration and cellulitis of the left foot and an x ray was taken to look for evidence of osteomyelitis (fig 1) The x ray showed no evidence of active osteomyelitis but did show tapering of the metatarsal bones and soft tissue calcification. The musculoskeletal manifestations of leprosy can include periostitis, osteitis, and osteomyelitis, usually due to the extension of infection from dermal or mucosal areas.1 Neuropathic changes include absorption of cancellous bone which gives rise to the “licked candy stick” appearance with tapering. Calcification in the soft tissues may reflect calcification of affected nerves.
Contributors:p j perkins*, g d summers†, *Rheumatology Department, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK; †Department of Rheumatology, Derbyshire Royal Infirmary, London Road, Derby DE1 2QY, UK.
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