the digits,'' also known as the opera-glass deformity. The hands of a patient with this deforming type of psoriatic arthritis are shown in Figure 20-64.

Tuberous sclerosis is a dominantly inherited hamartomatous disorder characterized by mental retardation, seizures, eye lesions, and skin lesions. The classic triad of symptoms is mental retardation, seizures, and adenoma sebaceum. Adenoma sebaceum occurs near the nasolabial folds and over the cheeks. These lesions are facial angiofibromas. Other common skin lesions are periungual and subungual fibromas. Figure 20-65A shows the foot of a patient with tuberous sclerosis and periungual fibromas. Figure 20-65B shows the foot of another patient with tuberous sclerosis and subungual fibromas.

Lesions of Kaposi's sarcoma are frequently seen on the feet. Figure 20-66 shows the foot of a patient who presented with this lesion between his fourth and fifth toes. A biopsy of the lesion confirmed the diagnosis of Kaposi's sarcoma. This was the patient's first manifestation of acquired immunodeficiency syndrome. Figure 20-67 shows the plantar arch of another patient who presented with painful nodules. A biopsy confirmed the diagnosis of Kaposi's sarcoma. Kaposi's sarcoma of the heel is pictured in another patient in Figure 20-68.

Another common podiatric complaint is an exostosis at the metatarsocuneiform joint, which produces a painful dorsal lesion. Figure 20-69A depicts this type of problem; Figure 20-69B is an x-ray film of the foot showing the bony abnormality.

Figure 20-70 shows severe paronychia with exuberant granulation tissue. Such lesions must be differentiated from amelanotic melanomas.

Although squamous cell carcinomas are usually found in sun-exposed areas, the lesion pictured in Figure 20-71 is on the plantar aspect of the foot. A callus is also present under the head of the first metatarsal.

Figure 20-65 A and B, The feet of two patients with tuberous sclerosis and periungual fibromas.

Figure 20-66 Kaposi's sarcoma between the toes.

Figure 20-66 Kaposi's sarcoma between the toes.

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Arthritis Relief and Prevention

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