Q. Can erythema nodosum occur at the same spot in both feet?



Hi doctor,

I am a 33 year old female with a history of erythema nodosum. I used to get outbreaks over my bilateral shins and ankles. Last bad outbreak was probably around seven to eight years ago. I woke up this morning with pain and swelling of the lateral parts of both the feet around the cuboid bone. The strange thing was that it continued to hurt with radiating pain throughout the day. I made a podiatrist appointment. After x-rays and examination, he diagnosed me with peroneal tendonitis and gave me orthotic boots and ankle braces to wear. The doctor seemed confused by the swelling and the fact that this happened so acutely with no injury, increase activity, etc. However, it did not hurt me until I reach home. I am realizing that the pain is so familiar, like my nodules, which I used to get on my shins. I am just wondering if it could really be erythema nodosum on that part of my foot and especially being that it is occurring bilaterally at the same exact location on each foot. Is this possible? Thank you so much for your help with this matter.





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We are here to help you.

  • Reading your case summary and studying the attached report (attachment removed to protect patient identity); I would say that the favorable diagnosis in your case would be erythema nodosum (inflammation of fat cells under the skin).
  • Characteristically, the lesions appear on the anterior legs, but can be present anywhere.
  • It can be bilateral or unilateral.
  • I would advise you to go for the following investigations:
  1. ESR (erythrocyte sedimentation rate).
  2. Throat swab for streptococcal.
  3. CRP (C-reactive protein).
  • In case these tests come out negative, then you should go ahead for ANA (antinuclear antibody) and skin biopsy to rule out vasculitis.

  • The Probable causes:

    Streptococcal infection.

  • Investigations to be done:

    ESR and swab.

  • Regarding follow up:

    Revert back with the investigation reports to a rheumatologist online.—> https://www.dr.sitehome.info/ask-a-doctor-online/rheumatologist




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