Marui Takashi, Yamamoto Tetsuji, Akisue Toshihiro, Hitora Toshiaki, Kawamoto Teruya, Nagira Keiko, Yoshiya Shinichi, Kurosaka Masahiro
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Foot Ankle Int. 2004 Feb;25(2):107-11. doi: 10.1177/107110070402500212.
Two cases of deep-seated neurilemmoma that arose from plantar branches of the posterior tibial nerve and caused chronic heel pain are described. At the initial examination, one case was misdiagnosed as tarsal tunnel syndrome and the other was overlooked as plantar fasciitis; both cases were treated for long periods prior to operation. Deep-seated neurilemmomas in the foot can easily be overlooked and misdiagnosed as tarsal tunnel syndrome or plantar fasciitis because of the rarity, absence of palpable mass, and similarity of symptoms to those of other frequently encountered foot disorders. Magnetic resonance imaging provides the best modality for differential diagnosis. In the present cases, surgical excision of the tumors resulted in immediate and complete relief of chronic heel pain. Surgeons should consider neurilemmoma as a cause of persistent chronic heel pain despite the rarity of the disease.
本文描述了两例起源于胫后神经足底分支并导致慢性足跟痛的深部神经鞘瘤。在初次检查时,一例被误诊为跗管综合征,另一例被误诊为足底筋膜炎;两例在手术前均接受了长期治疗。足部深部神经鞘瘤由于罕见、无明显肿块且症状与其他常见足部疾病相似,很容易被忽视并误诊为跗管综合征或足底筋膜炎。磁共振成像为鉴别诊断提供了最佳方式。在本病例中,手术切除肿瘤后,慢性足跟痛立即完全缓解。尽管该病罕见,但外科医生应考虑神经鞘瘤是持续性慢性足跟痛的一个病因。