Many disease processes may be manifest by foot lesions. Acquired immunodeficiency syndrome may present with a variety of foot lesions, including Kaposi's sarcoma and nonhealing ulcers and those caused by bacterial and fungal infections such as histoplasmosis (which can present as maculopapular eruptions or depressed pits of the soles).49 These patients may develop neuropathies presenting as both paresthesias and dysesthesias. Secondary syphilis presents as a nonitching polymorphic rash that affects both the soles and palms. The rash of Rocky Mountain spotted fever, which is initially discrete, macular, and later petechial, is also found on the palms and soles. Cutaneous forms of tuberculosis have also been described that affect the feet. Hand-foot-and-mouth disease causes small vesicular lesions on the soles, palms, buttocks, and in the mouth. This entity is caused by coxsackievirus and occurs in the late summer and fall.
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