Malignant soft tissue tumors of the foot and ankle are rare but diagnostic imaging and/or interventional biopsy are vital to establish the nature and grading of a suspicious tumor prior to definitive surgical intervention. The purpose of the study is to provide an account on how a symptomatic mass of the plantar aspect of the foot warranted a referral to a sarcoma center, highlighting the importance of having access to diagnostic imaging and a pathway to refer suspected cases to specialist centers. A single patient with a symptomatic soft tissue tumor of the plantar foot was referred from our service to the regional sarcoma center who considered to be benign, and therefore, open surgical resection was performed by our team. Histopathological analysis identified the excised mass as a lipoma. At 2 years, postoperatively there was no recurrence, and the patient presented with an asymptomatic foot. United Kingdom (UK) guidelines suggest that all soft tissue masses of suspicious nature, greater than 50 mm, deep seated irrespective of size, or fast growing lesions should be referred to a sarcoma unit prior to surgical management. European guidance identifies a threshold of 15 mm for a mass in the foot. Patients presenting with red flag symptoms irrespective of size of mass should be referred to a sarcoma center. Advanced imaging and multidisciplinary input to enable appropriate surgical planning is recommended for suspicious soft tissue tumors that present to the foot and ankle surgeon.
Intra articular steroid injection is a common treatment modality for relief of pain and inflammation associated with degenerative joint disease. Use of injectable steroid preparations is widely accepted as safe and effective for the treatment of osteoarthritis of the 1st metatarsophalangeal joint. Despite the frequency of use, literature specific to pathology of the 1st metatarsophalangeal joint is sparse. The aim of this systematic review was to determine if good quality research exists to enable clinicians to adopt an evidenced based approach to corticosteroid injection of the 1st metatarsophalangeal joint. Despite the frequency of use, this review found no high quality studies that support the use of intra articular corticosteroid injection of the 1st metatarsophalangeal joint in osteoarthritis.
Background: Soft tissue malignant tumours of the foot and ankle are rare. Diagnostic imaging and interventional biopsy are vital to establish the nature and grading of a suspicious tumour prior to surgical intervention. The purpose of the study is to provide an account on how a symptomatic mass to the plantar aspect of the foot warranted a referral to a sarcoma centre, highlighting the importance of having urgent access to diagnostic imaging and a pathway to refer suspected cases to specialist centres. Method: A single patient with a symptomatic soft tissue tumour of the plantar foot was referred from our service to the regional sarcoma centre. It was considered to be benign and therefore open surgical resection was performed under local anaesthesia by our team, and the lesion sent for histopathological examination. Results: Histopathological analysis identified the excised mass as a lipoma to show no atypia or necrosis and mature adipose tissue with fibrous bands. At 2 years postoperatively there was no recurrence and the patient presented an asymptomatic foot. Favourable patient reported outcomes measures were observed. Conclusion: United Kingdom (UK) Guidelines suggest that all soft tissue masses of suspicious nature, greater than 50mm, deep seated irrespective of size, or fast growing should be referred to a sarcoma unit prior to surgical management. European guidance identifies a threshold of 15mm for a mass in the foot. Patients presenting with red flag symptoms irrespective of size of mass should be referred to a sarcoma centre. Advanced imaging and multidisciplinary input to enable appropriate surgical planning is recommended for these soft tissue tumours that present to the foot and ankle surgeon. Level of evidence: V case study.
Background Corrective surgery for hallux abducto valgus is one of the most performed elective procedures in foot and ankle practice. Numerous methods of surgical correction have been reported within the literature, with varying clinical and patient reported outcomes. This study reviews the patient experience and outcomes in five podiatric surgery centres using the scarf diaphyseal osteotomy. Method Patient reported outcome measures (PROMs) were captured using the Patient Satisfaction Questionnaire 10 (PSQ-10), part of the PASCOM-10 podiatric surgery audit tool. PROMs were collated across five hospital sites over a 10-year period. Results Of 1351 patients reported during the period, 1189 had complete retrospective data. The most common patient aim of surgery was ‘no/less pain’ reported in 70% of patients. 96.8% of patients reported their original foot complaint as ‘better’ or ‘much better’ after surgery. 92.8% of patients reported their expectations had been met with 96.6% reporting they would have surgery again under the same conditions. 98.5% of patients noted that the risks, complications, and expectations had been discussed prior to surgery. The most common complication was metatarsal fracture (4.6%). Conclusion The scarf osteotomy (with or without an Akin phalangeal osteotomy) consistently showed high patient satisfaction with low complication rates using PSQ-10 and this information can be used as part of the pre-operative consenting process. Patient expectations for surgery were often achieved, which may be attributed to the pre-operative work up of the patient. Further investigation into this correlation is suggested. Level of clinical evidence IV (retrospective review).
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