You receive a referral from the local pain clinic to help a…
You receive a referral from the local pain clinic to help a gentleman with his small heel wounds. The pain clinic is treating him for bilateral leg pain that has persisted for over 6 months. Upon examination, you notice that his legs are lacking hair on the distal half of his legs, his toenails are thick and hyperkeratotic, the forefoot and plantar surfaces of his feet have moderate erythema with some areas of splotchiness. His wounds are small but 100% eschar. He reports that his leg pain gets worse at night in bed. What underlying etiology do you suspect?