Imaging Quiz: A Foot Rash With a Foul Odor

CPT Timothy L. Gardner, MD; LTC Dirk M. Elston, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 2 - FEBRUARY 98

A 24-year-old man presented to a dermatology clinic complaining of a "smelly" rash on his feet. The rash had developed during a period of intense training for a 20-km forced road march. He reported that the rash was asymptomatic, but that the odor was embarrassing at times.

The physical exam revealed multiple coalescing shallow pits on the patient's heels and soles (figure 1). There was no scale, erythema, edema, or tenderness with palpation, and a foul odor was indeed present.

What is your diagnosis, and what treatment would you recommend?

Dr Gardner is a resident in the department of dermatology and Dr Elston is chief of the dermatology service, both at the Wilford Hall Medical Center at Lackland Air Force Base in Lackland, Texas. Address correspondence to Dirk M. Elston, MD, 59th Medical Wing, Dept of Dermatology/MMID, 2200 Berquist Dr, Suite 1, Lackland AFB, Texas 78236-5300; e-mail to elston@whmc-lafb.af.mil.

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