Schwannomas are benign, encapsulated soft-tissue tumors that rarely present to the foot and ankle. These tumors are usually asymptomatic unless an increase in size or disruption of the nerve causes pain. We report a case of a painful mass along the lateral plantar nerve near the fourth metatarsal base that was surgically excised and confirmed as a benign schwannoma by means of histopathologic analysis. At the final follow-up of over 2 years, the patient reported no pain, neurologic deficits, or signs of recurrence. This case demonstrates an unusual location of a schwannoma arising from the lateral plantar nerve.

Background: Recurrent ulceration is a common problem after partial first-ray amputations. Loss of the first metatarsophalangeal joint contributes to altered biomechanics and increased pressure on the foot. This may increase risk of adjacent ulcerations and additional amputations. Preserving first-ray length maintains the metatarsal parabola and limits transfer lesions, but few data support this. We aimed to evaluate the incidence of ulceration after partial first-ray amputations and to assess the association between metatarsal protrusion distance and recurrent ulceration. Methods: Thirty-two consecutive patients underwent unilateral partial first-ray amputation at various levels along the first metatarsal, and the metatarsal protrusion distance was measured after surgery. Incidence of ulceration was evaluated on the ipsilateral foot. We hypothesized that patients with a longer first metatarsal were less likely to ulcerate again on the ipsilateral foot. Results: Fourteen patients (43.8%) ulcerated again after partial first-ray amputation. Mean time to ulceration was 104 days. Active smoking status was associated with increased risk of another ulceration (P = .02), and chronic kidney disease was associated with a decreased risk of recurrent ulceration (P = .03). The average metatarsal protrusion distance for patients who ulcerated again after surgery was 36.1 mm versus 25.9 mm for patients who did not (P = .04). Logistic regression analysis of the receiver operating characteristic curve demonstrated an ideal cutoff length for recurrent ulceration of 37 mm (area under the curve = 0.7381). Patients with a protrusion distance greater than 37 mm were nine times as likely to ulcerate again (95% CI, 1.7–47.0). Conclusions: Partial first-ray amputations can be a good initial salvage procedure to clear infection and prolong bipedal ambulatory status. Unfortunately, these patients are prone to recurrent ulceration. Significant loss of first metatarsal length is a poor prognostic indicator for recurrent ulceration.

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Dysplasia Epiphysealis Hemimelica (DEH) or Trevor's disease is a rare skeletal condition that forms osteochondroma like lesions in the epiphysis of long bones. This occurs mainly in pediatric patients with a predilection for the lower extremities. The knee and the ankle joint are most commonly affected in a hemimelic distribution meaning that either the medial or the lateral part of the center of ossification is affected. We report a rare case of Dysplasia Epiphysealis Hemimelica in an active pediatric patient involving multiple tarsal bones around the left ankle that was surgically excised after using a medial malleolar osteotomy for exposure. At over four years of follow up, our patient is pain free, has no growth arrest and continues to engage in normal activities.