Glomus tumors are rare and benign vascular soft-tissue masses commonly found subungually in the foot. A glomus tumor typically manifests with a classic triad of pain, point tenderness, and cold sensitivity. This case report describes an atypical presentation of a glomus tumor in the soft tissue of the rearfoot in a 77-year-old man in the setting of urosepsis. The mass had enlarged progressively for 6 months. Originally misdiagnosed as a hemangioma based on magnetic resonance imaging and clinical appearance, an excisional biopsy was performed. The lesion was subsequently diagnosed histopathologically as a glomus tumor. This article discusses the statistics of glomus tumor and discusses the importance of the need to recognize the symptoms and clinical findings of both typical and atypical presentation of this abnormality in differentiation and differential treatment and risk management of benign and malignant soft-tissue masses.
A 42-year-old woman presented to the emergency department with progressive painful discoloration of the digits of her right foot and symptoms previously diagnosed as neuroma. She was admitted to the hospital for dorsalis pedis arterial occlusion and ischemic foot pain. Despite attempts to restore perfusion to the right leg, ischemia of the right foot persisted and progressed to digital gangrene. The patient subsequently required right transmetatarsal amputation and eventually below-the-knee amputation. After extensive inpatient vascular and hematologic work-up of this otherwise healthy woman, test results revealed that she had protein S deficiency, hepatitis C, and human immunodeficiency virus type 1. In addition to describing this patient’s evaluation and treatment, we review protein S deficiency, including its correlation with human immunodeficiency virus type 1 infection and laboratory diagnosis. This case promotes awareness of protein S deficiency and serves as a reminder to the physician treating patients with vascular compromise and a history of human immunodeficiency virus type 1 to include protein S deficiency in the differential diagnosis. (J Am Podiatr Med Assoc 97(2): 151–155, 2007)
Antiphospholipid syndrome is an autoimmune disease characterized by vascular thrombosis involving both the arterial and venous systems that can lead to tissue ischemia or end-organ damage. Much of the literature describes various symptoms at initial presentation, but isolated tissue ischemia manifesting as a solitary blue toe is unusual. We discuss a case of a 23-year-old man who presented to the emergency department with a solitary blue fourth digit with minimal erythema and edema, who was suffering from exquisite pain. Following an extensive workup, the patient was diagnosed with antiphospholipid syndrome with thrombi of the vasculature in their lower extremity. With therapeutic anticoagulation, the patient's symptoms subsided and amputation of the digit was prevented.
Acquired constriction ring syndrome is a clinical condition of infancy characterized by circumferential constriction of a toe or another appendage, such as fingers and genitalia. The foot and ankle specialist should be aware of this condition because vascular obstruction of the affected appendage can rapidly lead to gangrene and autoamputation. Treatment consists of prompt identification and removal of the constricting foreign material. Although this condition is uncommon, it can lead to digital loss. Early treatment yields a good prognosis. A case report is presented of a 9-week-old infant who experienced acquired constriction ring syndrome caused by a strand of hair wrapped around the third and fourth toes that was treated by unwinding the hair under loupe magnification. (J Am Podiatr Med Assoc 96(3): 253–255, 2006)
Pernio is an inflammatory condition of the skin associated with cold exposure. The dermatologic manifestations may vary, and this entity is frequently misdiagnosed. Its association with systemic disease underscores the importance of accurate diagnosis. The authors describe a case report in which a patient who, after initially presenting with a complaint of pain and an ingrown toenail, was eventually diagnosed with pernio as well.
Classic Kaposi’s sarcoma is one form of Kaposi’s sarcoma. It is usually first seen in the skin of the lower extremities, where it is frequently misdiagnosed as a bruise. As time progresses, the lesions increase in size, number, and color. Early diagnosis is paramount to decrease metastasis to other organ systems such as the lungs, kidneys, and liver. The podiatric physician must take a detailed history, follow the course of the illness, and be aware that definitive diagnosis is made by a skin biopsy. This article provides a case history of Kaposi’s sarcoma and discusses diagnosis and treatment of this disease. (J Am Podiatr Med Assoc 95(6): 586–588, 2005)
There are few documented reports of arteriovenous malformations in the extremities, and even fewer specifically in the foot. Most of the documented cases in the foot present surgical treatments, and there is limited information on the nonsurgical approach. A brief review of the surgical approach to arteriovenous malformations in the foot and hand is presented first, followed by a case report of the nonsurgical treatment of an arteriovenous malformation in the foot, which was initially diagnosed incorrectly.
A 68-year-old man with a slow-growing lesion in the distal medial band of the plantar fascia of the left foot is presented. Clinical photographs, ultrasound and magnetic resonance images, histologic results, and immunochemical staining are disclosed. This case study presentation aims to highlight the importance of including angioleiomyoma in the differential diagnosis of plantar foot soft-tissue masses.
Angioleiomyomas are benign soft-tissue tumors that present painfully and are more commonly found in the extremities. Although benign soft-tissue tumors do not require excision, the clinician may not always know the type of tumor, and patient symptomatology may require removal of the offending body. In this article, we present our case findings of a 45-year-old man presenting with a subcutaneous angioleiomyoma subcalcis.
One of the more frequent pathologic conditions that podiatric physicians are confronted with is plantar verrucae. Plantar verrucae have been studied extensively in terms of morphological features and incidence in the population at large and in patients with human immunodeficiency virus infection. Solitary angiokeratomas can be morphologically similar to plantar verrucae, presenting as hyperkeratotic pedunculated lesions. We present a unique case study of a 40-year-old man with human immunodeficiency virus with a painful solitary angiokeratoma masquerading as plantar verrucae. The lesion demonstrated clinical signs consistent with those highlighted in the literature for verrucae, namely, showing as red and black lacunae, punctuated hyperkeratotic epidermis. We propose that solitary angiokeratomas should be an important part of a podiatric physician’s differential diagnosis in the lower extremity owing to the similarity of morphological features with plantar verrucae. (J Am Podiatr Med Assoc 100(6): 502–504, 2010)