. Physical diagnosis . Fig. 239.—Flat-foot. (Bradford and Lovett.) In Raynauds disease the digits are cold and painless or attacks are aggravated by heat and not (like those of Raynaudsdisease) by cold. Such attacks are probably akin to the condition of hot feet often seen in arteriosclerosis and myocarditis. The patientkicks off the bed clothes from his feet at night on account of the burn-ing sensations in them. Other evidence of insufficient arterial bloodsupply (, clubbing, intermittent claudication, cramps, gangrene)may coexist. The Toes. \ Many of the lesions already
. Physical diagnosis . Fig. 239.—Flat-foot. (Bradford and Lovett.) In Raynauds disease the digits are cold and painless or attacks are aggravated by heat and not (like those of Raynaudsdisease) by cold. Such attacks are probably akin to the condition of hot feet often seen in arteriosclerosis and myocarditis. The patientkicks off the bed clothes from his feet at night on account of the burn-ing sensations in them. Other evidence of insufficient arterial bloodsupply (, clubbing, intermittent claudication, cramps, gangrene)may coexist. The Toes. \ Many of the lesions already mentioned in the fingers are found alsoin the toes (, atrophic and hypertrophic arthritis, acromegaly, THE LEGS AND FEET 435 pulmonary osteoarthropathy, tuberculous or syphilitic dactylitis,tremors, spasms, and choreiform movements). Other lesions, suchas ingrowing toe-nail, bunion, hallux valgus, policemans heel, aretoo purely local to deserve description here. Excluding these wehave left:. Fig. 240—Rachitic deformity of leg bones. i. Gout, which is especially prone to attack the metatarso-phalan-geal joint of the great toe, producing all the classical signs ofinflammation. 2. Gangrene is usually the result of arteriosclerosis (see Fig. 241)with or without diabetes mellitus, but may result (as in the fingers)from arterial spasm or local asphyxia (Raynauds disease). 3. Perforating Ulcer.—In diabetes and sometimes in tabes atrophic or nutritional ulcer may develop in the toe or tarsus as a 436 PHYSICAL DIAGNOSIS result of nerve influences similar to those which produce Charcotsjoint or herpes zoster in the diseases just mentioned. It is calledperforating ulcer because of its stubborn progression despite a planof treatment that checks ordinary infectious abscesses. Actual per-foration is not often seen.
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