Photo Quiz: Unusual pits to the bottom of the foot

by Al Kline, DPM 1

The Foot & Ankle Journal 1 (9): 5

ISSN 1941-6806
doi: 10.3827/faoj.2008.0109.0005

Case History

A 21 year old female presents with unusual ‘pits’ along the bottom of the forefoot. (Figs. 1) The patient states that she has had the condition for over a year. She relates to going bare-footed and wearing sandals whenever possible. There is an associated pungent odor to her feet. She relates to having to wash her feet often. The patient initially thought it was just dirt that “didn’t wash off” in the bath. She became more concerned when the lesions and dark brown pits would not go away.


Figures 1    Dark-stained appearing pits to the bottom of the forefoot.   The patient attributed this condition to her feet getting dirty while going bare-footed.   However, it appeared that the ‘dirt’ would not wash off.

The patient’s medical history is unremarkable. She is allergic to Ceclor®. She does not take any prescription or over-the-counter medications.

The lesions or pits appear to be confined to the epidermis and seem to disappear with superficial debridement. (Figs. 2)


Figures 2    Closer clinical examination reveals tiny hollow pits and small craters within the epidermis.  Simple debridement does not reveal deeper keratosis. 

Question: Based on the patient’s clinical history, which of the following is the correct diagnosis?

A. Arsenical keratosis
B. Pitted keratolysis
C. Keratosis punctata
D. Keratosis pilaris
E. Intractable plantar keratosis
F. Porokeratosis plantaris discreta
G. Hyperhidrosis
H. Bromohidrosis

Address correspondence to: Al Kline, DPM. 3130 South Alameda, Corpus Christi, Texas 78404.

1 Adjunct Clinical Faculty, Barry University School of Podiatric Medicine. Private practice, Chief of Podiatry, Doctors Regional Medical Center. Corpus Christi, Texas, 78411.

© The Foot & Ankle Journal, 2008