Idiopathic neurotrophic feet in Blacks is a well known clinical entity (Perdikis and Bremner 1969; Trope and Crookes 1975). It is generally referred to by the descriptive term “vrot foot” which describes the decayed appearance of the neglected feet when first seen, characterized by ulceration of the sole of the foot in the region of the metatarsal heads, painless destruction of the bones of the feet and a peripheral neuropathy (Fig. 7.1). Usually no cause can be found. All the patients thus far reported have been males generally below the age of 50 years. Most were considered heavy drinkers and in most instances this takes the form of home brewed alcoholic beverages. Clinically, there is often a perforating ulcer on the undersurface of the foot with evidence of bony resorption and clawing. Most cases show a shortening of the toes and in some there are just stubbs remaining. This change is supposedly due to infection with osteolysis and absorption and also due to the neuropathy which apparently induces increased vascularity of the bone with resultant rarefraction. With progressive neuropathy there is eventually extension at the metatarso-phalangeal joints and flexion at the interphalangeal joints. The metatarsal head is pushed through the skin of the ball of the foot resulting in the perforating ulcer. A number of cases also have clinical pellagra. In nearly all cases no evidence of a vascular deficit has been found, but there is generally a neurological deficit affecting mainly light touch, pain and temperature. Perdikis and Bremner (1969) and Trope and Crookes (1975) suggest that the condition is the result of excessive ingestion of alcohol resulting in central and peripheral nerve degeneration. Clinically, the lesion is similar to diabetic neuropathy and the primary presentation is that of a peripheral neuropathy.
KeywordsPeripheral Neuropathy Diabetic Neuropathy Vascular Change Metatarsal Head Chronic Alcoholism
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