A case of mouth in foot disease

doi:10.1136/bmj.331.7514.427

BMJ 2005;331:427 (20 August), doi:10.1136/bmj.331.7514.427

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A case of mouth in foot disease

An elderly man was admitted to our hospital after being foundwandering the streets disorientated. He was found to have hada myocardial infarction and was soon on our ward and makinga good recovery. He continued to have some disorientation withreduced cognition and low mood. Progress was steady, however,until one day he developed a notable limp while walking on theward. He moved his legs freely enough but clearly limped onthe right leg.

Neurological examination was unremarkable, as was muscle andjoint examination; there was no tenderness or swelling present.Radiographs of his hips and pelvis seemed normal, but the limppersisted. The day of discharge was looming, and the team wasincreasingly uncomfortable with the prospect of the patientleaving with the cause of his limp still undiagnosed.

On his last day in hospital the consultant sat down with himand asked him straight: "Why do you have a limp?" The man lookedat the consultant and then calmly bent down, removed his rightshoe, and lifted out his top set of dentures and placed themgently on his table. The limp was immediately cured.

Jason Raw, specialist registrar in geriatrics

(jasonraw{at}msn.com), Chorley and South Ribble District General Hospital, Lancashire Teaching Hospitals Trust, Chorley

Naseer Naqvi, consultant geriatrician

Chorley and South Ribble District General Hospital, Lancashire Teaching Hospitals Trust, Chorley