J Korean Foot Ankle Soc.  2017 Dec;21(4):174-178. 10.14193/jkfas.2017.21.4.174.

Unusual Presentation of Traumatic Neuroma of the Medial Plantar Nerve after Deep Laceration Mimicking a Foreign Body Granuloma: A Case Report

• Woo SH
• Kim TW
• Bae JY

• KMID: 2398017
• DOI: http://doi.org/10.14193/jkfas.2017.21.4.174

Abstract

Traumatic neuromas are rare benign tumors that are common after trauma or surgery and are usually accompanied by obvious symptoms of pain. Most reports show neuromas in the face, neck, and limbs, and the traumatic neuroma of the medial plantar nerve has rarely been reported. We encountered a traumatic neuroma of the medial plantar nerve after a deep laceration mimicking a foreign body granuloma. A small mass lesion was found around plantar aponeurosis with heterogeneous high signal intensity in the T2 fat suppression view and slightly enhanced intensity in the magnetic resonance imaging that suggested a foreign body granuloma. The lesion was diagnosed pathologically as a traumatic neuroma. A satisfactory clinical result was obtained after excision of the traumatic neuroma and burial of the proximal and distal stumps to the adjacent muscle at the secondary operation.

Keyword

Foot; Tibial nerve; Neuroma

MeSH Terms

Burial
Extremities
Foot
Foreign Bodies*
Granuloma, Foreign-Body*
Lacerations*
Magnetic Resonance Imaging
Neck
Neuroma*
Tibial Nerve*

Figure

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  Figure 1 Axial T2-weighted fat suppression magnetic resonance imaging finding of the mass lesion. Ill-defined heterogeneous two high signal intensity lesion (asterisks) located lateral to flexor hallucis longus tendon.

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  Figure 2 Ultrasonographic finding of the mass lesion. Ill-defined heterogeneous hypoechoic lesion (asterisk) located between plantar aponeurosis (PA) and flexor hallucis longus (FHL) tendon.

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  Figure 3 Gross photo of specimens of first surgery: two separately round-in-shape masses about 7.0×5.0 mm and 5.0×3.0 mm, respectively.

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  Figure 4 Microscopic finding of the mass lesion of first surgery. It is characterized by a variably well-defined, but unencapsulated, mass of numerous axons and Schwann cells embedded in scar tissue adjacent (H&E stain, ×100).

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  Figure 5 Operative field findings during the second operation. (A) The medial plantar nerve was (arrow) surrounded by thick fibrous tissue (asterisk). (B) After excision of the fibrous tissue, multiple fusiform masses (arrows) were founded in the medial plantar nerve trunk. (C) Gross appearance of excised fibrous tissue surrounding multiple neuromas. (D) Gross appearance of excised medial plantar nerve including multiple traumatic neuromas.

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  Figure 6 Microscopic findings of the mass lesion of secondary surgery. It is composed of the newly formed neural tissue, failing to achieve continuity with the distal portion of the affected nerve, is arranged completely haphazardly (H&E stain, ×100).

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  Figure 7 Microscopic findings of the fibrous lesion. It is composed of the closely packed spindle cells in “feather-stitched” or storiform pattern (H&E stain, ×100).

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