What Is the Cause of This Man’s Blister?

asymptomatic blister front view

A 74-year-old man presented for evaluation of an asymptomatic blister on his left great toe. Five days prior to the appearance of the blister, he had purchased a new pair of walking shoes and walked several miles on 2 consecutive days. The following morning, he noted the blister on his toe. His past medical history is significant for atrial tachycardia, hyperlipidemia, and hypertension. His medications include aspirin, coenzyme Q10, finasteride, metoprolol, niacin, potassium chloride, rosuvastatin, valsartan-hydrochlorothiazide, and vitamin D. Physical examination shows a 20 × 20 mm tense blister filled with clear fluid on the lateral distal aspect of his left great toe involving the lateral nail fold (Figure 1). Neurologic examination of both feet revealed absence of plantar sensation. 

What is Your Diagnosis?

Answer on page 2

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