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We present the ultrasonographic morphology of an actinomycetoma of the foot at 18 and 70 MHz (high-frequency and ultrahigh-frequency ultrasound, respectively), and describe an ultrasonographic sign that may help to discriminate between eumycetoma and actinomycetoma called the “bright hyperechoic halo.” To date, this is the first report on the morphology of mycetoma at 70 MHz with a clinical, ultrasonographic, and histologic correlation of the images, which provides ultrasound images that are very similar to the lower magnification of histology.
Atypical Vascularity Within a Schwannoma
A Case Study
We report on the unusual presentation of a schwannoma. Aside from the aberrant dorsolateral anatomical presentation, ultrasonography revealed not only peripheral vascularity but also internal vascularity. Internal vascularity often suggests a malignant process as opposed to a benign one; however, in the presented case, the diagnosis of a benign lesion was confirmed with S100 immunohistochemical staining. In this study, we review the literature on this pathology and present an uncommon presentation of a benign nerve tumor.
Lipomas are the most common benign soft-tissue tumors found in the body. They tend to occur in areas of abundant adipose tissue, which explains why they are rarely found in the sole. Very few published cases of lipomas in the sole exist. When lipomas cannot be excised for histologic confirmation, ultrasonography has been shown to be a valuable assessment tool with high diagnostic capabilities. We present the case of 100-year-old patient with a long-standing plantar mass with late-stage clinical and sonographic features of a calcified lipoma.
Inclusion cysts are benign lesions that appear as a consequence of traumatic inclusion of epidermal cells into the dermis. They can be painful if they appear under pressure areas, especially the metatarsal heads. We report a case of a 36-year-old woman with an intractable plantar keratosis lesion under the third metatarsal head of 3 years’ duration. Ultrasonography revealed the presence of a subcutaneous mass with a growing epidermoid. It was surgically excised, and pathology confirmed the diagnosis of a plantar epidermoid cyst. All symptoms disappeared after the excision of the lesion. This case should alert the clinician about the existence of keratotic lesions in the metatarsal heads commonly diagnosed and treated as intractable plantar keratosis, although they are not directly derived from metatarsal overload. Some of the lesions could be directly derived from skin problems aggravated by pressure from the metatarsal head. This should be taken into consideration when addressing the management of these lesions. (J Am Podiatr Med Assoc 99(2): 148–152, 2009)
Tarsal Tunnel Syndrome Associated with a Pulsating Artery
Effectiveness of High-Resolution Ultrasound in Diagnosing Tarsal Tunnel Syndrome
We describe a patient with tarsal tunnel syndrome in whom ultrasound imaging revealed compression of the posterior tibial nerve by a pulsating artery. High-resolution ultrasound showed a round pulsating hypoechoic lesion in contact with the posterior tibial nerve. Ultrasound-guided injection of 0.5% lidocaine temporarily resolved the paresthesia. These findings suggest an arterial etiology of tarsal tunnel syndrome. (J Am Podiatr Med Assoc 100(3): 209–212, 2010)
Solid-cystic hidradenoma is a benign cutaneous tumor with eccrine sweat gland origins that is most commonly found in the head, neck, trunk, and upper extremity regions of patients in the middle to older age groups. These lesions are generally asymptomatic, slow-growing, solitary, and nonulcerative in presentation. Degenerative malignant transformation of this tumor is very rare. In this case report, the authors describe the marginal surgical excision and subsequent microscopic pathologic diagnosis of a moderate sized solid-cystic hidradenoma of the dorsolateral forefoot in a middle-aged male patient.
Diagnosis and treatment of longitudinal tears of the tibialis anterior tendon are not well documented in the surgical literature. Described here is successful primary surgical repair of a longitudinally torn tibialis anterior tendon in a 60-year-old woman. (J Am Podiatr Med Assoc 95(4): 390–393, 2005)
The foot is considered the second most common location for foreign bodies. The most common foreign bodies include needles, metal, glass, wood, and plastic. Although metallic foreign bodies are readily seen on plain film radiographs, radiolucent bodies such as wood are visualized poorly, if at all. Although plain radiography is known to be ineffective for demonstrating radiolucent foreign bodies, it is often the first imaging modality used. In such cases, complete surgical extraction cannot be guaranteed, and other imaging modalities should be considered. We present a case of a retained toothpick of the second metatarsal in a young male patient who presented with pain in the right foot of a few weeks' duration. Plain radiography showed an oval cyst at the base of the second metatarsal of the right foot. Magnetic resonance imaging revealed a toothpick penetrating the second metatarsal. The patient recalled stepping on a toothpick 8 years previously. Surgical exploration revealed a 2-cm toothpick embedded inside the second metatarsal.
Giant cell tumor of the tendon sheath (GCTTS) in the foot is a rare pathology and is involved in the differential diagnosis of soft-tissue tumors of the foot and ankle. Although it can affect any age group, GCTTS mainly occurs at the 3rd and 5th decade and is more common in females. Histopathologic examination is a major definitive method for diagnosis, although physical examination and radiologic imaging are helpful in reaching a diagnosis preoperatively. Many treatment options exist but marginal excision is the most commonly used treatment. We describe the case of a 26-year-old pregnant woman with a multi-fragmented mass extending from the first web space to the plantar aspect of the metatarsophalangeal joint (MTP) of the left great toe associated with flexor hallucis longus tendon after trauma. She had pain that worsened with activity and wearing shoes. After pregnancy, a marginal excision with dorsal longitudinal incision in the first web space was performed under spinal anesthesia. The lesion was diagnosed as a localized type tenosynovial giant cell tumor. At the last follow-up appointment in the 23rd month, the patient was doing well and there was no recurrence of the lesion. GCSST should be considered in the differential diagnosis of plantar masses of foot. Although, GCTTS is frequently seen in females, it has not been previously reported in a pregnant woman with an extremely rare condition after trauma.
Metatarsalgia is characterized by pain in the forefoot, which is associated with increased stress over the metatarsal head region. Despite the availability of a variety of conservative or surgical treatments for this condition, a few cases have demonstrated relapse or poor response to treatment. Pulsed radiofrequency (PRF) can provide pain relief in patients with diverse chronic conditions without causing neural injury. Recently, studies have shown that ultrasound-guided PRF may be beneficial for adhesive capsulitis, carpal tunnel syndrome, tarsal tunnel syndrome, and recalcitrant plantar fasciitis. Here, we describe a successful case of significant pain relief achieved by using ultrasound-guided PRF targeting the posterior tibial nerve (PTN) at the ankle of a 67-year-old woman with recalcitrant metatarsalgia. Ten minutes after ultrasound-guided PRF was applied at the PTN, the patient reported decreased pain (from 8 to 3 on a visual analogue scale) and did not exhibit any particular side effects. Three months after PRF application, the patient's visual analogue scale score remained more than 50% below the baseline, and she did not need additional conservative treatment during the follow-up period. To the best of our knowledge, we present the first case report using ultrasound-guided PRF at the PTN for treatment of recalcitrant metatarsalgia. We hypothesize that ultrasound-guided PRF at the PTN may be a potentially novel approach for treating recalcitrant metatarsalgia.
