Cover Journal of the American Podiatric Medical Association
Journal of the American Podiatric Medical Association
ISSN:
8750-7315
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Online Publication Date:
Sep 2012

Incidental Findings of Massive Heel Spurs in a Veteran with a Variant of Psoriatic Arthritis

Danae L. Lowell Podiatric Surgery, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH.

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Lawrence S. Osher Departments of Podiatry and Radiology, Kent State University, College of Podiatric Medicine, Independence, OH.

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Angela F. Grady Podiatric Surgery, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH.

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DOI:
https://doi.org/10.7547/1020422
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A middle-aged man presented for left foot diabetic ulcer care. Pedal radiographs were negative for signs of osteomyelitis. However, asymptomatic incidental osseous findings demonstrated significant plantar and posterior calcaneal spurring possibly consistent with diffuse idiopathic skeletal hyperostosis (DISH). A differential of DISH, psoriatic arthritis, Reiter’s, and ankylosing spondylitis was developed. Subsequent spinal imaging and laboratory work-up did not satisfy the diagnostic criteria for DISH. This case illustrates radiographic changes characteristic of multiple seronegative arthropathies. On initial presentation a diagnosis of DISH was most likely, but with further imaging studies a diagnosis of a variant of psoriatic arthritis may be more correct. (J Am Podiatr Med Assoc 102 (5): 422-427, 2012)

Corresponding author: Danae L. Lowell, DPM, Podiatric Surgery, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard (W112), Cleveland, Ohio 44106. (E-mail: danae.lowell@va.gov)
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