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Blue/Red Fluid Filled Lump Adhered to Plantar Fascia?!?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kerrie, Apr 13, 2011.

  1. Kerrie

    Kerrie Active Member

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    Hi All,
    Right here is one to stump your brains, well it stumped mine let me tell you

    20 year old girl, fit and healthy with no significant foot problems or pathomechanics, BUT......

    Approx 3/4 years ago injured foot traumatically by falling oddly and had severe pain in region of plantar fascia at point of injury. Now, there is a 1cmx1cm fluid filled lump adhered to the fascia, I can see the blue/red tinge beneath the skin and as I move the fascia via the windlass at the hallux the lump moves but causes excruitating agony for the patient.

    I'm going to wrtie back to the GP for some tests to be done as I think we really need to find out what this is.

    Any ideas what anyone thinks that this could be and also what tests to request. I am already thinking that soft tissue investigation (mri/ultrasound) is essential

    Thanks Guys
  2. A photograph and more patient information would be helpful here.
  3. Kerrie

    Kerrie Active Member

    Ok, Ummm.
    She cannot remember how she injured it but knows that she did, she thinks that she may have fallen oddly etc and at that point she felt a severe stab in the region of the fascia (she drew her finger along her arch indicating where it hurt) this was 3/4 years ago and the lump has been present since.
    The lump is just distal to the medial calcaneal tubercle by approximately a thumbs width and there is a significant blue/red tinge to it, it appears almost vascular due to the colouring. On palpation it feels soft and fluid filled, not hard, although proper examination was too painful for the patient as she kept flinching. It is not perfectly round or pronouced (it does not stick out but can be more felt on palpation) and has not changed the surface texture of the skin although there seems to be an area of red staining/extravastion on the skin localised to one point. It does definitely not look like a ganglion or anything of this sort. No localised heat.
    With regards to it articualting with the fascia as I was moving her hallux and able to see the fascia moving the lump moved with it without changing it's location on the fascia. This was very painful and the patients foot spasmed with each move
    It will keep her awake at night by 'tingling away' and although it is painful all the time it is exacerbated by direct pressure such as catching a door ledge wrong.
    All GP's have fobbed her off in the past saying that it is nothing to worry about but I think it is
    Unfortunately I cannot get a picture as I would have to go through mass consent forms and locate a camera in the NHS ;) but I hope that this has provided enough information
  4. W J Liggins

    W J Liggins Well-Known Member

    Hello Kerrie

    Even a pic from a 'phone (they're pretty good these days) would help. A single consent form would suffice, since the picture itself offers 'implicit' consent.

    As far as investigations are concerned, I would start with an ultrasound; if the Radiologist has any concerns re: his/her opinion, then they will say so and advise whether further investigation eg. MRI is necessary.

    Hope this helps

    All the best

  5. David Smith

    David Smith Well-Known Member

    Does this sound like a rupture of the plantar fascia? fits very well to two case histories in the paper attached 'Rupture of the Plantar Fascia in Athletes'.


    Attached Files:

    Last edited: Apr 13, 2011
  6. drsarbes

    drsarbes Well-Known Member

    After trauma 9 months ago (I assume that's what 3/4 of a year is) there are only a limited number of pathologies that would be "fluid" filled.

    Organized hemangioma/aneurysm

    That's all I can think of off the top of my head.

    A hematoma would have either resorbed or consolidated into a mass by now.

    Why not just giver her a PT block and aspirate it.
    If it's a sticky mess it's a ganglion;
    fresh blood - hemangioma;
    pus -abscess;
    non viscous clear sticky fluid - synovial cyst.

    good luck


  7. Kerrie

    Kerrie Active Member

    That was my backburner thought but can someone really walk around with a ruptured fascia for 3/4 years? She walks fine :S
  8. Kerrie

    Kerrie Active Member

    Sorry by 3/4 years I mean 3-4 years
  9. W J Liggins

    W J Liggins Well-Known Member

    Well, she wouldn't immediately afterwards but it may have been a partial rupture.

    I go along with Steve on the diff diagx, but it'd probably be worth investigating anyway.

    All the best

  10. lucycool

    lucycool Active Member

    no chance it could be a varicose vein? I know bizarre thought, but I had a pt in last month with similar and that's what it turned out to be..

  11. bob

    bob Active Member

    Hello Kerrie,
    Bill is right. Refer on to a podiatric surgeon + imaging (ultrasound or MRI). My money is on haemangioma or inclusion dermoid/ cyst. Given it's size, I would say excision is the most likely treatment.

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