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The fact that osteomyelitis or a similar change in the bones is a factor of great importance as the underlying local pathologic process in perforating ulcer of the foot is insufficiently appreciated. This study is based on observations on 33 cases of malum perforans pedis. Perforating ulcer of the foot was first described by Vesigne in 1852, and the condition was designated by Leplat in 1855. The underlying changes in the bones are significant in explaining some of the basic factors of the condition. The skeletal changes in this condition were noted and described by Savory and Butlin as early as 1879 in a paper which remains a classic. Bony sequestration formed a prominent feature of the clinical picture in their 5 cases. They stated that perforating ulcer might well begin in the depths of the foot or that the initial processes might begin almost simultaneously throughout the whole depth
KULOWSKI J, PERLMAN R. SKELETAL CHANGES IN MALUM PERFORANS PEDIS. Arch Surg. 1936;32(1):1-21. doi:10.1001/archsurg.1936.01180190004001