The ulcer that wouldn’t go away

Case history

Ruth is 68 years old and has a 3 cm wide, shallow ulcer on the ball of her left foot, which also is misshapen by a bunion (Figure 1). She says that she first became aware of the ulcer about three weeks ago when her foot stuck to her shoe; on looking, she had found a large sore on the sole of her foot. Within a week, the sore has enlarged. Since then, it had not worsened, but it also had not improved. There was no pain and Ruth was not too worried about it. However, when her daughter found out she insisted that Ruth come and see you.