Intramuscular haemangioma of abductor hallucis muscle - A rare case report

A Rare Case of Plantar Intramuscular Hemangioma: Diagnostic Challenges and Surgical Management in a 34-Year-Old Female

Hemangiomas are benign tumors of the soft tissues, with intramuscular hemangiomas (IMHs) being an exceptionally rare subtype. Intramuscular hemangiomas (IMHs) typically occur in younger adults and often involve the lower limbs, particularly the thigh. Localization in the foot is exceedingly rare. These tumors are often asymptomatic but may present with pain and swelling, especially during activity, posing diagnostic challenges. A 34-year-old female presented with a one-year history of progressive, persistent pain on the plantar side of her left foot. The pain, described as a deep ache exacerbated by weight-bearing activities, led to gait impairment and limping. Physical examination revealed significant tenderness but no swelling, erythema, or muscle atrophy. The X-ray reveals no abnormalities, prompting further evaluation with MRI. Imaging revealed an ill-defined vascular lesion involving the flexor digitorum longus and brevis tendons and adjacent muscles. Surgical excision was performed, and histopathology confirmed a cavernous hemangioma. The patient's postoperative course was uneventful, with immediate pain relief and restored function. Intramuscular hemangiomas (IMHs) are rare, locally aggressive benign tumors that are often misdiagnosed due to their nonspecific symptoms and rarity, particularly in the plantar region. Imaging, particularly MRI, plays a pivotal role in identifying characteristic features and guiding management. Histological confirmation remains essential for diagnosis. While surgical excision is the preferred treatment for symptomatic intramuscular hemangiomas (IMHs), recurrence and functional impairment remain concerns, underscoring the importance of proper diagnosis and intervention. This case emphasizes the importance of recognizing rare presentations of intramuscular hemangiomas (IMHs), such as in the plantar foot. A multidisciplinary approach, imaging, and histological analysis are crucial for accurate diagnosis and management. Long-term follow-up is necessary to monitor recurrence and ensure functional recovery.

Rare Case of an Intramuscular Hemangioma of the Foot: A Case Report With a Review of the Literature

Hemangiomas are benign tumors characterized by an abnormal proliferation of blood vessels, which can be particularly challenging to diagnose and manage when located in unusual sites such as the foot. Herein, we report a case of a 36-year-old woman with a plantar hemangioma on the right foot, characterized by a long-standing, periodically changing subcutaneous lump. Clinical examination and magnetic resonance imaging revealed a hyperintense mass involving the musculus flexor digitorum brevis. The patient underwent surgical excision, which was complicated by intraoperative rupture of the mass but ultimately resulted in complete removal. Histopathological analysis confirmed the diagnosis of an intramuscular hemangioma. Postoperative recovery was uneventful, and follow-up showed no recurrence after six months. This case highlights the critical role of accurate diagnosis through physical examination and imaging, particularly magnetic resonance imaging, to differentiate benign hemangiomas from malignant tumors and guide treatment. While surgical excision is the primary treatment for symptomatic or cosmetically concerning hemangiomas, less invasive alternatives like sclerotherapy may be appropriate for superficial lesions. Effective management requires precise diagnostic imaging and a tailored therapeutic approach.

Ultrasound of the plantar foot: a guide for the assessment of plantar intrinsic muscles

Plantar intrinsic muscles play a pivotal role in posture control and gait dynamics. They help maintain the longitudinal and transverse arches of the foot, and they regulate the degree and velocity of arch deformation during walking or running. Consequently, pathologies affecting the plantar intrinsic muscles (for instance, acquired and inherited neuropathies) lead to foot deformity, gait disorders, and painful syndromes. Intrinsic muscle malfunctioning is also associated with multifactorial overuse or degenerative conditions such as pes planus, hallux valgus, and plantar fasciitis. As the clinical examination of each intrinsic muscle is challenging, ultrasound is gaining a growing interest as an imaging tool to investigate the trophism of these muscular structures and the pattern of their alterations, and potentially to follow up on the effects of dedicated rehabilitation protocols. The ten plantar intrinsic muscles can be dived into three groups (medial, central and lateral) and four layers. Here, we propose a regional and landmark-based approach to the complex sonoanatomy of the plantar intrinsic muscles in order to facilitate the correct identification of each muscle from the superficial to the deepest layer. We also summarize the pathological ultrasound findings that can be encountered when scanning the plantar muscles, pointing out the patterns of alterations specific to certain conditions, such as plantar nerves mononeuropathies.