Unexplained Redness and Swelling in the Foot: Seeking Answers

Q: Unexplained Redness and Swelling in the Foot: Seeking Answers

Dear readers： Regarding the issue of "unexplained redness and swelling in the foot," here is the response：<br>A： 1. <br>You are a very attentive and patient person; it is rare for someone to keep such detailed records of their medical history. <br>2. <br>The progression of the wo

Unexplained redness and swelling of the foot?

At the end of the text, there are images.
Since there is a lot of text, I will summarize the key points first: From this past Monday (12/18) to yesterday (12/23), I have been taking antibiotics for five days.
The wound does not feel significantly better and still hurts.
It is bearable when walking, but it hurts more when my foot is stationary on the ground.
Currently, I plan to finish the antibiotics and see an infectious disease specialist on Monday or Tuesday.
However, I am worried because I have seen many doctors who do not know the cause, and the wound still looks severe.
The hospital has not conducted any blood tests.
I would like to ask if any symptoms can be identified or if there are any suggestions.
Thank you.

Details are as follows: One day last week, a red spot appeared near my ankle, probably around Monday (12/11) or Tuesday (12/12).
I do not remember the exact date, but since there was no wound, it did not itch or hurt, so I did not pay much attention.
By last Friday (12/15), I suddenly felt some pain and noticed that the red spot had enlarged, so I went to a nearby dermatology clinic.
The doctor asked about my recent activities, but I had mostly stayed at home, and even when I went out, I wore shoes and did not go to the countryside.
After examining for a long time, he was uncertain about the diagnosis and suspected it might be an insect bite, so he prescribed some topical medication.
By this Monday (12/18), the redness not only did not subside but had also increased.
I was awakened from sleep due to pain, and when I got out of bed in the morning, the pain was so severe that I could not stand.
I immediately went to the hospital's dermatology department, but the doctor said he did not know what it was, possibly inflammation, and prescribed a seven-day course of antibiotics (cephalexin capsules) to take and reassess afterward.
By evening, the wound appeared to be worse, so I went to another dermatology clinic.
The doctor immediately identified it as a bacterial infection, localized cellulitis, and advised me to continue taking antibiotics.
He also prescribed an antibiotic ointment (fusidic acid cream) to apply twice daily and said to return if there was no improvement in three days.
I took pain medication before bed.
I researched online and found that cellulitis should be evaluated by an infectious disease specialist, and it is recommended to keep the foot elevated.
Since then, I have been trying to sit and keep my foot elevated.
Although it has been somewhat painful these past two days, I have not taken pain medication.
By Thursday (12/21), I felt that the black spot seemed to be diminishing, but the redness had spread again.
After returning to the previous dermatology clinic, the doctor suspected it might be an embolism and suggested we see a cardiologist at a major hospital.
After examining me, the cardiologist felt it did not seem like an embolism and recommended seeing an infectious disease specialist, but since this was not his area of expertise, he was hesitant to provide further advice.
Therefore, we went to the infectious disease department at the same hospital.
The infectious disease doctor looked at the photos and felt that it seemed to be improving.
Since I was already on antibiotics, he advised me to wait until I finished them.
I asked if it was normal for the wound to still hurt, and he said it was uncertain, but improvement always takes time, and I should continue to monitor it.

I am not sure if it was because I wore shoes that day, but by evening, the wound appeared redder, and I was again awakened by pain during the night, prompting me to take pain medication.
Yesterday morning (12/22), I took pain medication again, but after a whole day, I felt no significant improvement, and the pain seemed more pronounced yesterday and today.
Throughout the day, I had taken pain medication three times.
I currently plan to finish the antibiotics and see the infectious disease specialist on Monday or Tuesday.
Do you have any suggestions? I am really worried because I have taken antibiotics for five days without knowing the issue, and I cannot tell if there has been any improvement.

Below are photos taken daily from 12/15 (Friday) to 12/22 (Friday):
1.
12/15 (Friday) - I felt some pain, so I went to the dermatology clinic.
The reflection is due to the topical medication applied.

2.
12/16 (Saturday) - Second day of applying the medication, a black spot appeared.

3.
12/17 (Sunday) - Third day of applying the medication, the black spot grew larger.

4.
12/18 (Monday) - Took the antibiotics prescribed by the hospital (cephalexin capsules) and switched to the antibiotic ointment (fusidic acid cream) from the dermatology clinic.
I took pain medication today because it hurt more.

5.
12/19 (Tuesday) - Second day of taking and applying antibiotics.

6.
12/20 (Wednesday) - Third day of taking and applying antibiotics.

7.
12/21 (Thursday) - Fourth day of taking and applying antibiotics; I went out this day and wore shoes for a few hours, and I started taking pain medication again.

8.
12/22 (Friday) - Fifth day of taking and applying antibiotics; I felt a lot of pain throughout the day, so I took pain medication three times.

Kong Bai, 60~69 year old female. Ask Date: 2017/12/23

Dr. Liao Zhongxin reply Internal Medicine

Dear readers: Regarding the issue of "unexplained redness and swelling in the foot," here is the response:
A: 1.
You are a very attentive and patient person; it is rare for someone to keep such detailed records of their medical history.
2.
The progression of the wound over the past 11 days can be quite concerning for both the patient and the attending physician.
3.
At the age of 63, it is likely that there are chronic conditions present, such as cardiovascular disease, diabetes, or other illnesses, which may affect immune function and healing speed due to medications taken.
4.
Recommendations: (1) Stick to one or two physicians for prescriptions and simplify the medication regimen.
(2) Clean the wound with povidone-iodine or antiseptic solution twice daily, but avoid excessive washing of the wound.
(3) Consult a nearby medical facility to check for any coagulation abnormalities, and avoid excessive scratching or trauma to the wound.
Thank you!

Reply Date: 2017/12/23

More Info

It sounds like you are experiencing a complex and concerning issue with your foot, particularly with the redness, swelling, and pain that has persisted despite treatment. Based on the information you've provided, it appears that you have been through a thorough process of consultations with various specialists, including dermatologists and infectious disease experts.
First and foremost, it is important to understand that persistent redness and swelling in the foot, especially if accompanied by pain, can be indicative of several underlying conditions. The fact that you have been prescribed antibiotics suggests that your healthcare providers are concerned about a possible bacterial infection, such as cellulitis or, as one doctor suggested, cellulitis. This condition can occur when bacteria enter through a break in the skin, leading to inflammation and infection in the surrounding tissues.

The presence of a black dot and the increasing size of the red area are concerning signs that warrant close monitoring. It is not uncommon for infections to take time to resolve, and the pain you are experiencing could be a result of inflammation as your body fights off the infection. However, if the redness continues to expand or if you develop additional symptoms such as fever, chills, or increased pain, it is crucial to seek immediate medical attention.

In terms of management, continuing the prescribed antibiotics is essential, as they are intended to combat the infection. It is also advisable to keep the affected area elevated to reduce swelling and to avoid putting weight on it as much as possible. Applying a cold compress may help alleviate some of the pain and swelling as well.
If you do not see improvement after completing the course of antibiotics, or if your symptoms worsen, it is important to follow up with your healthcare provider. They may consider further diagnostic tests, such as blood tests or imaging studies, to better understand the underlying cause of your symptoms.
Additionally, if there is any suspicion of a more serious condition, such as a vascular issue or a deeper infection, your doctor may refer you to a specialist for further evaluation. It is also worth discussing your concerns about the pain and the lack of improvement with your healthcare provider, as they may need to adjust your treatment plan or explore alternative therapies.

In summary, while it is understandable to feel anxious about your condition, it is important to remain in close contact with your healthcare providers and to adhere to their recommendations. Keep monitoring your symptoms, and do not hesitate to seek further medical advice if your condition does not improve or if you have any new concerns. Your health and well-being are the top priority, and timely intervention can make a significant difference in your recovery.

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