The Differential Diagnosis of Foot Lumps: 101 Cases Treated Surgically in North Glasgow Over 4 Years

Abstract

INTRODUCTION There are a wide variety of different lesions which present as lumps of the foot. There have been very few studies which look at the presenting characteristics or the differential diagnosis of such lesions.PATIENTS AND METHODS All patients who underwent excision or biopsy of a foot lump over a period of 4 years were studied in order to determine patient demographics, presenting characteristics, diagnoses encountered and to assess the diagnostic accuracy of the surgeon. RESULTS In total, 101 patients were identified. Average age was 47.3 years (range, 14-79 years); there was a marked female preponderance with 73 females and 28 males. Thirty different histological types were identified; ganglion cysts were the most commonly encountered lesions and there was only one malignant lesion encountered in this study. Only 58 out of the 101 lumps were correctly diagnosed prior to surgery. Certain lesions were more commonly encountered in specific zones of the foot. CONCLUSIONS We have shown that there are a wide variety of potential diagnoses which have to be considered when examining a patient with a foot lump. There is a low diagnostic accuracy for foot lumps and, therefore, surgical excision and histological diagnosis should be sought if there is any uncertainty.

Paresthesia and hypesthesia in the dorsum of the foot as the presenting complaints of a ganglion cyst of the foot

“…The reason for this may well be that even though ganglion cysts are relatively frequent causes of foot lumps, their absolute incidence is rather low (Bakotic and Borkowski, 2001;Macdonald et al, 2007). In addition to this, ganglion cysts do not usually produce neurological symptoms (Brooks, 1952;Kliman and Freiberg, 1982;Harbaugh et al, 1997;Rozbruch et al, 1998;Pontious et al, 1999;Rawal et al, 2004;Macdonald et al, 2007).…”

“…Ganglion cysts are more frequently located on the dorsum of the wrist, the palm of the hand, and the dorsolateral aspect of the foot. (Fleegler, 2006;Vatansever et al, 2006;MacDonald et al, 2007). It has been recently shown that ganglion cysts of the foot represent nearly 39% of lumps in that region (Macdonald et al, 2007).…”

“…By 1952, Brooks (1952 had already described 13 cases of peripheral nerve compression due to ganglion cysts. Reviewing the literature on foot lumps, neurological symptoms are considered to be very rare at presentation, with only one out of 101 patients complaining of paresthesia in Macdonald's series (Macdonald et al, 2007).…”

Fine-Needle Aspiration Biopsy of the Distal Extremities

“…Also, positive history of trauma, mass size, and even duration of symptoms is unreliable in discriminating neoplastic from nonneoplastic processes with regard to the distal extremities. 5,9 In some publications, preoperative clinical accuracy distinguishing benign or malignant neoplasms is less than 60%. 8,9 It must be remembered that more than 100 distinct histopathologic tumor types can arise from the skin, soft tissue, and bone in these locations.…”

“…One reason for this may be the infrequency of malignancy in this location (<2% of all cases). [2][3][4][5][6][7][8][9][10] Previously, only 2 studies have specifically commented on the use of FNAB in the hand and wrist. 7,8 And, with the exception of scattered case reports or distal extremity cases reported within larger series, FNAB of the foot and ankle region has been largely neglected.…”