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We report a rapidly spreading necrotizing foot infection in a healthy 37 year old male with associated sepsis and no identifiable portal of entry. A 37-year-old white male presented to the Emergency Department complaining of a very painful and swollen right foot. The patient denied a history of trauma or laceration to the foot, as well as any illicit drug use. Figure 1  The initial presentation of the foot.  There is extensive cyanotic skin changes and bullae formation.
The patient was taken to the operating room for incision and drainage, at which time seropurulence was expressed from all major compartments of the foot. On hospital day three, it was discovered that the cultures from the foot revealed Group A Streptococcus.

Figures 3,4   Appearance of the foot after amputation of the fourth toe prior to the fourth surgical debridement.  There is continued necrosis of soft tissue and loss of tissue viability to toes 1-3. In our case, rapid identification of the NSTI and septicemia contributed to our ability to preserve life and limb, through a foot sparing amputation. This entry was posted in Uncategorized and tagged diabetic foot infection, LRINEC score, Necrotizing soft tissue infection. The patient noted that the swelling and pain had been increasing to the lower leg and up to the knee.
We review the current literature of the diagnosis and treatment of necrotizing soft tissue infections in the foot. The clinician must realize that the pathognomonic skin changes do not appear until four or five days after initial presentation of pain, swelling and erythema.

The patient had been evaluated at an urgent care clinic five days earlier with a complaint of severe pain to the arch.
The most common presenting signs of NSTI are nonspecific signs of inflammation such as erythema, edema, and pain.

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Comments to “Foot problems pain in arch”

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  2. TELEBE_367a2:
    That point there is an onset of discomfort, which is usually felt on or about.