INSUBCONTINENT EXCLUSIVE:
X-rays of the ankle showed swelling in the soft tissue but without some signs of infection
The doctors wondered if the man had osteomyelitis, an infection in the bone, which can be a complication in people with diabetic ulcers
The large size and duration of the ulcer matched with a bone infection, as well as some elevated inflammatory markers he had on his blood
tests.To investigate the bone infection further, they admitted the man to the hospital and ordered magnetic resonance imaging (MRI)
But the MRI showed only a soft-tissue defect and a normal bone, ruling out a bone infection
Another MRI was done with a contrast agent
prolonged standing, as the man did at his laundromat job.As the doctors were still working to root out the cause, they had started him on a
heavy-duty regimen of antibiotics
This was done with the assumption that on top of whatever caused the ulcer, there was now also a potentially aggressive secondary
the doctors broadened their view of possibilities, newly considering cancers, rare inflammatory conditions, and less common conditions
affecting small blood vessels (as the MRI has shown the larger vessels were normal)
This led them to the possibility of a Martorell's ulcer.These ulcers, first described in 1945 by a Spanish doctor named Fernando Martorell,
form when prolonged, uncontrolled high blood pressure causes the teeny arteries below the skin to stiffen and narrow, which blocks the blood
supply, leading to tissue death and then ulcers
The ulcers in these cases tend to start as red blisters and evolve to frank ulcers
They are excruciatingly painful
