title: Incidental findings of massive heel spurs in a veteran with a variant of psoriatic arthritis.
abstract: A middle-aged man presented for left foot diabetic ulcer care. Pedal radiographs were negative for signs of osteomyelitis. However, asymptomatic incidental osseous findings demonstrated significant plantar and posterior calcaneal spurring possibly consistent with diffuse idiopathic skeletal hyperostosis (DISH). A differential of DISH, psoriatic arthritis, Reiter's, and ankylosing spondylitis was developed. Subsequent spinal imaging and laboratory work-up did not satisfy the diagnostic criteria for DISH. This case illustrates radiographic changes characteristic of multiple seronegative arthropathies. On initial presentation a diagnosis of DISH was most likely, but with further imaging studies a diagnosis of a variant of psoriatic arthritis may be more correct.
authors.affiliation: Podiatric Surgery, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA. danae.lowell@va.gov
authors.forename: Danae L
authors.initials: DL
authors.lastname: Lowell
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Osher
authors.forename: Angela F
authors.initials: AF
authors.lastname: Grady
mesh_terms: D015535:Arthritis, Psoriatic / Q000175:diagnosis*; D058070:Asymptomatic Diseases; D017719:Diabetic Foot / Q000628:therapy; D036982:Heel Spur / Q000175:diagnosis*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D014728:Veterans