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Background: Lipomas, derived from adipose tissue, most frequently occur in the cephalic regions and proximal extremities, but rarely in the toes. We aimed to highlight the clinical features, diagnosis, and treatment of lipomas of the toes., Methods: We analyzed 8 patients with lipomas of the toes who were diagnosed and treated during a 5-year period., Results: Lipomas of the toes were equally distributed by sex. Patients ranged in age from 28 to 67 years (mean age, 51.75 years). Six patients (75%) had a single lesion, and all of the patients developed lipomas on the hallux. Most patients (75%) presented with a painless, subcutaneous, slow-growing mass. The duration from symptom onset to surgical excision ranged from 1 month to 20 years (mean, 52.75 months). Lipoma size varied from 0.4 to 3.9 cm in diameter (mean, 1.6 cm). Magnetic resonance imaging showed a well-encapsulated mass with hyperintense signal on T1-weighted images and hypointense signal on T2-weighted images. All of the patients were treated with surgical excision, and no recurrences were found at mean follow-up of 38.5 months. Six patients were diagnosed as having typical lipomas, one a fibrolipoma, and one a spindle cell lipoma, which needs to be differentiated from other benign and malignant lesions., Conclusions: Lipomas of the toes are rare, slow-growing, painless, subcutaneous tumors. Men and women are equally affected, usually in their 50s. Magnetic resonance imaging is the favored modality for presurgical diagnosis and planning. Complete surgical excision is the optimal treatment, with rare recurrence.

Acquired digital fibrokeratoma is a rare and benign fibrous tumor; it is usually asymptomatic, and frequently arises from the fingers. The diagnosis is easily confirmed by pathologic evaluation. However, in some cases, it may be misdiagnosed as other benign conditions, mainly adnexal tumors and common warts, especially when located on the foot and toes. In this article, we report the case of a 45-year-old man who presented to our clinic for an acquired growth over the plantar surface of the second right toe. The tumor had evolved for 1 year and affected the patient's activities and mobility. On examination, the lesion was a dome-shaped, firm tumor with keratotic distal changes and a broad base attached to the overlying skin. Pathologic assessment was consistent with the diagnosis of acquired digital fibrokeratoma, ruling out other causes of abnormal growth. The tumor was completely excised with surgery, with excellent outcomes and no recurrence at follow-up. Although acquired digital fibrokeratoma is a rare condition, mostly located on the distal upper extremities and fingers, it should be considered in the differential diagnosis of plantar soft-tissue tumors. Surgical management remains the mainstay of treatment.

Glomus tumors are relatively rare benign tumors originated from normal glomus bodies. These tumors make up approximately 2% of all hand tumors and are most commonly found in the nail matrix and proximal nail bed of the hands. Histopathologically, they are classified into solid glomus tumor, glomangioma, and the least common type glomangiomyoma. Here we report an unusual case of subungual glomangiomyoma of the toe with dermatoscopic and histopathologic findings., (American Podiatric Medical Association.)

Osteoid osteoma is a benign tumor originating from osteoblasts, and it is mostly seen in long bones of lower limbs. The distal phalanx of the foot is an atypical location for an osteoid osteoma, and lesions occurring in this location may be a diagnostic challenge. A 22-year-old man presented with a complaint of severe pain on the second distal phalanx of his right foot. An osteoid osteoma was suspected after radiologic evaluation. The lesion was surgically excised and removed completely by curettage. Histopathologic evaluation confirmed the diagnosis of an osteoid osteoma. The patient was followed-up for a 9-month period without any symptoms or recurrence.

Polyarteritis nodosa is a progressive, often life-threatening, vasculitis affecting multiple organs, including the skin and peripheral nerves. We report a patient presenting with systemic features of the disease and with characteristic lesions in the feet 3 weeks after vaccination against hepatitis B virus infection.

Background:: Magnetic resonance imaging (MRI) is both sensitive and specific in the diagnosis of osteomyelitis, and it is an important imaging modality in preoperative planning of resection of infected bone. In many cases, however, the extent of osseous infection is evident on plain radiographs, and little additional information is gained from the MRI. The goal of this study was to assess the accuracy of radiographs against MRIs in assessing the spread of suspected osteomyelitis from one phalanx to another or to a metatarsal., Methods:: A medical record review was performed, and 14 patients with 16 toes confirmed to have osteomyelitis involving one or more phalanges were included in the study. An investigator blinded to the MRI findings interpreted the extent of osseous involvement based solely on the radiographic and clinical presentation. The accuracy of the radiographic interpretation was then calculated against the MRI findings., Results:: In 14 of the 16 toes (87.5%), whether osteomyelitis had spread from one bone to another was determined based on the radiographic and clinical presentation. In one toe, the radiograph did not adequately depict osteomyelitis in adjacent infected bone. In one more toe, the radiograph depicted features of osteomyelitis in uninfected bone., Conclusions:: In a large percentage of patients, the phalanges affected by osteomyelitis had visible findings on the radiograph, and operative planning could have been based on the radiograph alone.

Acral fibrokeratoma is a rare soft-tissue mass, more commonly found on the hands and rarely on the feet. This case report of a 40-year-old Hispanic man highlights an unusually located acral fibrokeratoma on the second toe, describes the clinical presentation and microscopic and pathologic findings, discusses differential diagnoses, and presents treatment options.

This report highlights an unusual case of an atypical melanocytic proliferation in a pediatric patient and the surgical method used to repair the defect. I describe a 10-year-old boy with hallux irregular discoloration that was present from birth and rapidly enlarging. A biopsy led to the diagnosis of atypical melanocytic proliferation, which may represent an unusual manifestation of early melanoma in situ. Complete excision of the patch was performed, and the hallux was repaired using a double advancement flap for closure, thus curing the patient.

A glomus tumor is an uncommon, predominantly benign, neoplastic lesion that primarily involves a thermoregulatory microvascular apparatus, the glomus body. Although these lesions can occur anywhere in the body, the subungual tissue of the hand represents the most common presentation site. Glomus tumors are not often encountered in the foot. Symptoms traditionally include the classic triad of pain, pressure, and cold sensitivity. This case report describes a variant location for a glomus tumor in the subcuticular tissue adjacent to the medial middle phalanx of the second toe. The nonsubungual location for this presentation should prompt the inclusion of glomus tumor in a digital soft-tissue lesion differential diagnosis. The lesion was excised surgically and was subsequently diagnosed histopathologically as a glomus tumor.

Verrucous carcinoma of the foot is a rare malignancy, and proper diagnosis can be delayed. Furthermore, misdiagnosis often results in delayed appropriate treatment. Herein, we present an unusual case of verrucous carcinoma of the fifth toe with bone invasion in a 63-year-old woman that was mistaken for a plantar wart for 3 years. The condition was treated by ray amputation. We emphasize the need for appropriate biopsy to achieve an accurate diagnosis.

Bizarre parosteal osteochondromatous proliferation (BPOP) is an uncommon reactive mesenchymal lesion mainly affecting the small bones of the hands and feet. They frequently occur in young adults. It is important to understand and differentiate BPOP from other lesions, especially because of its atypical microscopic features and tendency to recur. We present a case of a recurrent lesion involving the toe and discuss management options. To our knowledge, our current case report is the first in the literature to report a recurring BPOP lesion of the toe.

Squamous cell carcinoma is a common disease of cutaneous tissue with a great ability to form metastases. Squamous cell carcinoma is found most commonly on sun-damaged skin and has a rare occurrence on the toes and feet. The patient was a 68-year-old woman who was seen at a podiatric specialty office with a complaint of pain in her left great toe and toenail. Radiographs displayed erosion of the distal hallux, and magnetic resonance imaging revealed no further spread of disease in the proximal phalanx. An amputation was performed of the hallux interphalangeal joint, and pathology confirmed squamous cell carcinoma of the verrucous type.

It is accepted that immunosuppressant therapy after organ transplantation is associated with an increase risk of neoplasm. Subungual squamous cell carcinoma of the toe is a rare condition and has not previously been reported, to our knowledge, in patients undergoing immunosuppressant therapy. The objective of this case study is to report the clinical and histopathologic findings and the multidisciplinary treatment approach for a case of subungual squamous cell carcinoma of the toe in an organ transplant recipient undergoing immunosuppressant drug therapy.

Background: Although there is no ideal foot type for classical dancers, second-toe length seems to be a factor in the etiology of foot disorders in ballet dancers., Methods: We investigated the relationship between second-toe length and foot disorders in 30 ballet dance students and 25 folk dance students. Second-toe length in relation to the hallux (longer or equal/shorter), hallux deformities, first metatarsophalangeal joint inflammation, number of callosities, and daily pain scores were recorded in both groups and compared., Results: There was no statistically significant difference in toe length between the two groups (P>.05). Ballet dancers with equal-length or shorter second toes had lower pain scores, less first metatarsophalangeal joint inflammation, and fewer callosities in their feet compared with dancers with longer second toes., Conclusions: Second-toe length seems to be a factor in the development of forefoot disorders in classical ballet dancers but not folk dancers. Dancers who have equal-length or shorter second toes in relation to the hallux may have fewer forefoot disorders as dance professionals.

Acquired constriction ring syndrome is a clinical condition of infancy characterized by circumferential constriction of a toe or another appendage, such as fingers and genitalia. The foot and ankle specialist should be aware of this condition because vascular obstruction of the affected appendage can rapidly lead to gangrene and autoamputation. Treatment consists of prompt identification and removal of the constricting foreign material. Although this condition is uncommon, it can lead to digital loss. Early treatment yields a good prognosis. A case report is presented of a 9-week-old infant who experienced acquired constriction ring syndrome caused by a strand of hair wrapped around the third and fourth toes that was treated by unwinding the hair under loupe magnification.

We describe the management of a patient who presented to a family-practice clinic with gangrenous digits. After a thorough evaluation, she was found to have protein C deficiency, which produced a hypercoagulable state. Differential diagnosis in the evaluation of the coagulopathic patient with appropriate hematologic tests is briefly discussed.

We report a case of macrodactyly of the foot in a 3-year-old girl. The standard treatment for this condition has been ablation. Studies of phalangeal resection, phalangeal amputation, syndactylization, digit shortening, tissue debulking, and osteotomy have shown varying results. In the case reported here, debulking combined with a shortening osteotomy was the treatment of choice. Although the pediatric patient may require additional surgeries because the deformity will continue to grow, early treatment has allowed this child the benefit of a functional, cosmetically appealing foot that can be fitted with normal footwear.

Extraskeletal chondroma is a rare, benign cartilaginous tumor seen most frequently in the soft tissues of the hands and feet. The authors present a case of extraskeletal chondroma in a 52-year-old male patient who had a small mass on the left foot involving the flexor surface of the second toe. Radiographs showed the presence of a soft-tissue mass with scattered calcified foci. Surgical excision revealed a benign, lobulated cartilaginous tumor with prominent areas of calcification. Histologically; the lesion consisted of cartilage cells with centralized zones of cellular pleomorphism and giant-cell proliferation at the tumor margin consistent with extraskeletal chondroma.

While there have been several reports of upper and lower extremity amputations secondary to meningitis and purpura fulminans in the literature, the incidence is probably rare. Delmas et al studied five pediatric subjects with gangrene caused by meningococcemia, with four requiring amputation. Weiner reported that all 12 patients in his review received a lower extremity amputation, with several requiring upper extremity amputation. Joint contracture, while not as commonly discussed as amputation, is nonetheless an important and perhaps more common finding. Urbaniak et al indicated that of six patients reviewed, three developed significant joint contractures. With the exception of the gangrenous changes discussed, it was joint contracture that was the most limiting factor in progression to full activity and weightbearing in the authors' subject. Prompt, aggressive physical therapy is tantamount to effecting an acceptable long-term outcome.

The neurilemoma is a benign neoplasm of Schwann's cells arising from the sheath of a nerve. This neoplasm most commonly originates from the flexor surface of the body. An unusual presentation of a neurilemoma on the extensor surface of the foot was described. The treatment plan was explained, and pathologic characteristics were outlined. Trauma as a possible etiology was also described.

One of the most frequent causes of epidermal inclusion cysts is trauma involving the epidermis with subsequent implantation of epidermal cells into the dermis or subcutis. Minimal incision surgery is capable of achieving this because it is performed by using small incisions and rapidly rotating power instruments. The technique requires that the surgeon master a high degree of dexterity and knowledge of the anatomy without the aid of direct visualization. Van Enoo and Cane suggest the use of fresh, sharp skin blades to protect against invagination of skin edges which could lead to epidermal inclusion cysts. They also state that an improper position or an incision that is too small will cause tension, which can lead to heat buildup with subsequent sloughing and dehiscence. It may also drive some epidermal cells underneath the dermis and foster an epidermal cyst. Other surgeons using small incisions suggest thorough and copious irrigation to flush away debris and to avoid potential foreign body reactions. The periosteum should be reflected away from the point where the drill bit exits the bone to prevent bone chips from being forced subperiosteally and potentially causing a foreign body reaction. By virtue of the technique, minimal incision surgery lends itself to a greater risk of causing epidermal inclusion cysts. Surgeons who use these techniques must be aware of this potential complication.