Calcaneal intraosseous lipoma: A rare cause of heel pain

Maatallah, Kaouther; Boudokhane, M.; Ferjani, H.; Kaffel, Dhia; Kchir, Mohamed Montacer; Hamdi, Wafa

doi:10.1016/j.ejr.2019.01.003

“…Such tumors may develop at any age and have no gender predilection. Intraosseous lipoma tends to have non-specific clinical manifestations and it is often misdiagnosed, as in our case [ 5 ]. It may be misdiagnosed as plantar fasciitis, plantar bursitis, stress fracture, aneurysmal bone cyst, and other benign tumors.…”

Section: Discussionmentioning

confidence: 98%

“…In the early stages of the intraosseous lipoma, the magnetic resonance imaging shows a high signal intensity in T1 and T2-weighted images that are isointense to the subcutaneous fat and demonstrates suppression on the short tau inversion recovery sequence [ 9 ]. However, later stages of lipoma may have areas of low signal intensity in T1 and high signal intensity in T2 representing fat necrosis or cyst formation along with signal void areas in keeping with calcification [ 5 ]. In the present case, magnetic resonance imaging was noted performed because of its cost.…”

Section: Discussionmentioning

confidence: 99%

Intraosseous Calcaneal Lipoma Misdiagnosed as Plantar Fasciitis: An Orthopedic Case From Family Practice

Alnooh¹,

Furaikh²,

Alaithan³

et al. 2022

Cureus

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Foot pain is a prevalent musculoskeletal complaint with plantar fasciitis being one of the most common underlying etiologies. Diagnostic imaging studies are rarely performed for patients with plantar fasciitis. We report the case of a 34-year-old woman with a six-month history of left heel pain that was worsened by prolonged standing and walking. She was diagnosed as having plantar fasciitis. Considering the lack of clinical improvement on conservative measures, the patient underwent a plain radiograph, which demonstrated a geographic radiolucent lesion in the calcaneus with well-defined non-sclerotic margins. Subsequently, a computed tomography scan re-demonstrated the lesion as having a fat-attenuation appearance that was classic of lipoma. The patient underwent surgical excision of the tumor and the histopathological examination of the specimen revealed spindle cell lipoma. The patient had complete resolution of the pain following the surgery. Intraosseous lipoma is a very rare benign primary bone tumor. The case demonstrated that the intraosseous lipoma may have similar clinical features to plantar fasciitis. Hence, physicians should keep a high index of suspicion for the alternate diagnoses of plantar fasciitis in patients who do not exhibit any clinical improvement despite a prolonged period of conservative management.

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“…Intracranial lipomas constitute 0.1-0.5% of all primary brain tumours [2]. Intraosseous lipoma is a rare subset of osteolipoma seen in the calcaneus representing 0.1% of all skeletal tumours and often incidentally discovered during radiological imaging [25,26,27]. The incidence of benign lipoma to the sole of the foot is uncommon [21,28,29].…”

Section: Introductionmentioning

confidence: 99%

Surgical excision of complex lipoma from the foot: a case report 

Uddin

¹

,

Flanagan

²

,

Reilly

³

2020

Preprint

0

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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.

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“…Intraosseous lipoma is a rare subset of osteolipoma seen in the calcaneus representing 0.1% of all skeletal tumours and often incidentally discovered during radiological imaging [25,26,27]. The incidence of benign lipoma to the sole of the foot is uncommon [21,28,29].…”

Section: Introductionmentioning

confidence: 99%

Surgical excision of complex lipoma from the foot: a case report 

Uddin

¹

,

Flanagan

²

,

Reilly

³

2020

Preprint

0

View full text Add to dashboard Cite

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.

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Calcaneal intraosseous lipoma: A rare cause of heel pain

Cited by 3 publications

References 17 publications

Intraosseous Calcaneal Lipoma Misdiagnosed as Plantar Fasciitis: An Orthopedic Case From Family Practice

Intraosseous Calcaneal Lipoma Misdiagnosed as Plantar Fasciitis: An Orthopedic Case From Family Practice

Surgical excision of complex lipoma from the foot: a case report

Surgical excision of complex lipoma from the foot: a case report

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Calcaneal intraosseous lipoma: A rare cause of heel pain

Cited by 3 publications

References 17 publications

Intraosseous Calcaneal Lipoma Misdiagnosed as Plantar Fasciitis: An Orthopedic Case From Family Practice

Intraosseous Calcaneal Lipoma Misdiagnosed as Plantar Fasciitis: An Orthopedic Case From Family Practice

Surgical excision of complex lipoma from the foot: a case report&nbsp;

Surgical excision of complex lipoma from the foot: a case report&nbsp;

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Surgical excision of complex lipoma from the foot: a case report

Surgical excision of complex lipoma from the foot: a case report