A rare and unusual case of plasma cell dyscrasia of the calcaneus is presented. Clinically, the patient had a draining and painful ulcer that was treated with appropriate antibiotics and wound care but failed to show any signs of healing. Radiographic images showed cystic changes of the calcaneus in the vicinity of the ulcer. Blood work was negative for bone and soft-tissue infection, but uric acid and alkaline phosphatase levels were elevated. Nuclear bone scan showed increased uptake in the calcaneus suggestive of osteomyelitis. One possible differential diagnosis was an intraosseous gouty tophus deposit. Not convinced that this was either a bone infection or gout, the author performed a bone biopsy. Pathologic evaluation indicated plasma cell dyscrasia. Continued wound care healed the ulcer completely, with resolution of pain of his heel. Oncology/hematology was consulted, and 16 months after biopsy, he remains asymptomatic.
An unusual case of solitary benign schwannoma of the foot is presented. Clinical examination, magnetic resonance imaging, and intraoperative findings all confirm the suspicion of a ganglion cyst. After attempted aspiration failed to produce any aspirate, excisional biopsy was performed. The pathology report confirms schwannoma with hematoxylin and eosin stain and subsequently reaffirmed with positive S100 protein stain. Even though schwannoma of the foot had been reported in the literature, this was an unusual case, as the lesion was presented as a superficial, ganglion cyst–like lesion on the bottom of the foot.