Search Results
Giant-cell tumor of the tendon sheath (GCT-TS) is an uncommon occurrence for a foot and ankle surgeon. However, there is a need to recognize the symptoms of typical and atypical presentations of this pathology. These benign neoplasms are recognized clinically as a soft-tissue mass that is usually painless and palpable. The foot and ankle account for only 3% to 5% of all GCT-TS in the body, with most being located in the hand. Giant cell tumor in the tendon sheath occurring in the foot and ankle is usually encountered on the lateral ankle and dorsum of the foot, occupying the extensor tendons. Additionally, it is commonly misdiagnosed clinically. This case study illustrates how early use of magnetic resonance imaging decreased patient morbidity with early recognition and excision of GCT-TS.
Accessory soleus muscle is an uncommon anatomical variant that may present as a soft-tissue mass in the posteromedial region of the ankle. It is congenital in origin but usually presents in the second or third decade of life. Although it is a rare entity, accessory soleus muscle should be included in the differential diagnosis of soft-tissue swelling of the ankle. Awareness of the clinical presentation and specific findings of computed tomography, magnetic resonance imaging, and electromyography help with diagnosis without surgical exploration. We describe a 30-year-old patient with accessory soleus muscle. Magnetic resonance imaging features of the case are described, and the literature is briefly reviewed. (J Am Podiatr Med Assoc 94(6): 587–589, 2004)
Tourniquet failure is attributed to inadequate tourniquet pressure, inadequate exsanguination, failure to compress medullary vessels within the bone, and incompressible calcified arteries. We herein report a case of massive bleeding using a properly functioning tourniquet in a patient who had bilateral calcified femoral arteries. When incompressible calcified arteries are present, the inflated tourniquet cuff fails to adequately compress the underlying artery, yet acts as an efficient venous tourniquet, which leads to an increase in bleeding. It is therefore critical to preoperatively confirm the effectiveness of the tourniquet in arterial occlusion in patients with severe arterial calcification.
The superficial fibular (peroneal) nerve traditionally courses through the anterolateral deep leg and pierces the deep crural fascia at the lower leg to divide into its terminal branches. Entrapment of the superficial fibular nerve is most commonly documented to occur at where it pierces the deep fascia, and numerous etiologies causing entrapment are described. In this case report, we describe an unusual cause of entrapment from a tertiary branch of the superficial fibular nerve taking a circumflex course and wrapping around the secondary branch of the main nerve. This was successfully treated by surgical excision. To the best of our knowledge, this cause of entrapment has not been described in the literature at the time of this publication.
Ablative fractional laser is suggested to promote wound healing in diabetic and venous leg ulcers. In this article, we report the treatment outcome of a recalcitrant foot ulceration related to lower leg arteriopathy. A 43-year-old man with typical digital substraction angiographic findings of arteriopathy was admitted to our department after 30 sessions of hyperbaric oxygen therapy. There was heterotopic tissue within the ulcer consistent with osseous metaplasia and mature bone tissue. This tissue was removed with full-field erbium:yttrium-aluminum-garnet laser, and the remaining parts received fractional erbium:yttrium-aluminum-garnet laser for the induction of wound healing. A decrease in ulcer dimensions was achieved by the second month of laser interventions without recurrence in the first-year control.
Tenosynovial giant cell tumor, also known as giant cell tumor of the tendon sheath (GCT-TS), is a solitary, nodular, firm, benign, soft-tissue tumor that arises from the synovial lining of a tendon. The etiology is unknown. It is a rare soft-tissue tumor, with an overall incidence of one in 50,000 individuals, and usually affects people aged between 30 and 50 years. Magnetic resonance imaging tends to be the imaging modality of choice, used for surgical preparation. Widely accepted treatment involves local excision with or without radiotherapy. The author presents a case study involving a patient with an abnormally large, longstanding GCT-TS, diagnosed with clinical examination and imaging modalities, surgically excised, and further confirmed by pathology reports. Topic of discussion includes a review of GCT-TS.
Ganglion cysts have been recorded in many areas throughout the body. Intratendinous ganglion cysts in the foot are very rare. We present the case of 51-year-old woman with a recurrent right foot ganglion cyst. Surgical excision revealed a ganglion cyst in the tendon sheath of the extensor digitorum longus. It is important to be aware of potential tendon involvement for ganglion cysts, as surgeons must be prepared to perform tendon repairs in addition to mass excisions if the tendon is compromised.
Subungual Glomangiomyoma
An Unusual Case with Dermatoscopic and Histopathologic Findings
Glomus tumors are relatively rare benign tumors originated from normal glomus bodies. These tumors make up approximately 2% of all hand tumors and are most commonly found in the nail matrix and proximal nail bed of the hands. Histopathologically, they are classified into solid glomus tumor, glomangioma, and the least common type glomangiomyoma. Here we report an unusual case of subungual glomangiomyoma of the toe with dermatoscopic and histopathologic findings.
Background
One of the most common causes of heel pain is plantar fasciitis; however, there are other pathologic disorders that can mimic the symptoms and clinical presentation of this disorder. The purpose of this study was to retrospectively review the prevalence of various pathologic disorders on ultrasound in patients with proximal plantar heel pain.
Methods
The medical records and diagnostic ultrasound reports of patients presenting with plantar heel pain between March 1, 2006, and March 31, 2007, were reviewed retrospectively, and the prevalence of various etiologies was collected. The inclusion criteria were based on their clinical presentation of plantar fasciitis or previous diagnosis of plantar fasciitis from an unknown source. Ultrasound evaluation was then performed to confirm the clinical diagnosis.
Results
We examined 175 feet of 143 patients (62 males and 81 females; age range, 16–79 years). Plantar fibromas were present in 90 feet (51%). Plantar fasciitis was diagnosed in 128 feet (73%). Coexistent plantar fibroma and plantar fascial thickening was found in 63 feet (36%). Of the 47 feet that were negative for plantar fasciitis on ultrasound, 27 (57%) revealed the presence of plantar fibroma.
Conclusions
Diagnostic ultrasound can effectively and safely identify the prevalence of various etiologies of heel pain. The high prevalence of plantar fibromas and plantar fascial tears cannot be determined by clinical examination alone, and, therefore, ultrasound evaluation should be performed for confirmation of diagnosis.
Background: The aim of this study was to evaluate the results of high-dose extracorporeal shockwave therapy applied with an ankle block and corticosteroid injection in patients with plantar fasciitis whose symptoms persisted for more than 6 months.
Methods: Sixty patients were assessed clinically at presentation and at 3-month follow-up with a patient-assessed 100-mm visual analog scale of pain and a physician-assessed heel tenderness index. A therapeutic response rate was evaluated. A decrease of at least 50% from baseline to 3 months in visual analog scale or heel tenderness index scores was accepted as a successful result.
Results: Extracorporeal shockwave therapy and corticosteroid injection provided significant improvements in visual analog scale and heel tenderness index scores, but between the two groups there was no significant difference in the visual analog scale score change 3 months after treatment (P > .05). Twenty-seven of 33 patients (82%) in the extracorporeal shockwave therapy group and 23 of 27 (85%) in the corticosteroid injection group had a successful therapeutic response after 3 months.
Conclusions: Corticosteroid injection and extracorporeal shockwave therapy are successful treatment modalities for plantar fasciitis. Corticosteroid injection treatment is cost effective compared with extracorporeal shockwave therapy, and corticosteroid injection may be the first treatment choice according to these results. (J Am Podiatr Med Assoc 100(2): 105–110, 2010)
