Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea.
Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea.
Int J Environ Res Public Health. 2021 Aug 28;18(17):9088. doi: 10.3390/ijerph18179088.
Intramuscular hemangioma (IH) is rare, accounting for only 0.8% of all hemangioma cases. In particular, IH of the foot has only been reported a few times. In such cases, the symptoms typically include tenderness and swelling, often in relation to physical activity, but tingling or impaired function may also be present. Here, we report a patient who presented with a significant IH in the plantar area treated surgically. A 25-year-old female visited our hospital with pain in the plantar aspect of the right foot. She had noticed a mass about 10 years prior. She had previously experienced pain only when pressing the mass, but the pain subsequently became more regular pain and was exacerbated by exercise. In fact, the pain became so intense that she could not sleep well. Upon physical examination, mild swelling and tenderness of the plantar area were noted in the second to the fourth metatarsal. Sensation and motor reflexes were normal and the results of Tinel's test were negative. Plain radiographs of the right foot revealed phleboliths scattered throughout the first to third intermetatarsal spaces. Magnetic resonance imaging revealed a space-occupying multilobulated mass (5.6 × 2.8 × 2.5 cm) located in the flexor digitorum brevis (FDB) muscle, which penetrated the plantar fascia and spread to the subcutaneous layer. In T2-weighted images, the lesion displayed a hyperintense signal compared to the surrounding skeletal muscle. Based on radiological findings, we suspected IH. The mass surrounded by the FDB muscle was exposed and completely removed via wide excision. IH consisting of cavernous-like vascular structures was diagnosed on pathology. At 1-year follow-up, the patient was almost asymptomatic and had recovered almost full range of motion in the plantar area. Histological analysis and surgery are recommended to remove intramuscular hemangiomas in the plantar area, but if the patient is not suitable for surgery, sclerotherapy or combination treatment should also be considered.
肌内血管瘤（IH）较为罕见，仅占所有血管瘤病例的 0.8%。特别是足部 IH 仅报道过几次。在这种情况下，症状通常包括压痛和肿胀，通常与体力活动有关，但也可能出现刺痛或功能障碍。在这里，我们报告了一例手术治疗的足底巨大 IH 患者。一位 25 岁女性因右足底疼痛就诊于我院。10 年前她发现了一个肿块。之前她仅在按压肿块时感到疼痛，但后来疼痛变得更加规律，并因运动而加重。事实上，疼痛变得如此剧烈，以至于她无法睡好觉。体格检查发现第二至第四跖骨足底区轻度肿胀和压痛。感觉和运动反射正常，Tinel 征阴性。右足正位片显示第一至第三跖骨间散在静脉石。磁共振成像显示位于趾短屈肌（FDB）内的占位性多叶肿块（5.6×2.8×2.5cm），穿透足底筋膜并延伸至皮下层。在 T2 加权图像上，病变与周围骨骼肌相比呈高信号。基于影像学表现，我们怀疑为 IH。FDB 肌包绕的肿块被暴露并通过广泛切除完全切除。病理诊断为海绵状血管结构组成的 IH。1 年随访时，患者几乎无症状，足底区域的运动范围已基本恢复。建议对足底肌内血管瘤进行手术切除，但如果患者不适合手术，也可以考虑硬化治疗或联合治疗。
