Missing the wood for the trees - A case of recalcitrant foot ulcer.

Nwabudike, L C; Gutu, D

A 78-year old male with longstanding type 2 diabetes presented with a 3-year history of left plantar ulcer. The patient reported occasional pain at the lesion. It had been treated as a neuropathic, diabetic ulcer with various topical agents. He did not report using offloading therapy. Examination revealed an ulcer on the sole of the left foot, over the area of the 3rd and 4th metatarsal heads, with well-defined margins surrounded by callus. The base was pink with several islands suggestive of epithelialisation (Fig. 1). The wound margins did not appear undermined. There was no surrounding erythema or oedema. The patient's glycated haemoglobin was 7.12%. Working diagnosis was squamous cell carcinoma (possible Marjolin's ulcer).