Mass-Like Fat at the Medial Midfoot

NewsBot · Aug 6, 2021

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Mass-Like Fat at the Medial Midfoot: A Common Pseudolesion
Colin D. Strickland, Luke W. Patten, Michael J. Durst, Alexander N. Merkle
Indian Journal of Radiology and Imaging

Background Fatty masses are common and may be encountered in the foot and ankle. In some cases, normal subcutaneous fat may be mistaken for a discrete mass.

Aims The aim of this study was to evaluate the common finding of prominent subcutaneous fat at the medial midfoot resembling a lipoma and to determine the prevalence of this pseudolesion by applying a series of potential size cutoff criteria.

Materials and Methods Three musculoskeletal radiologists retrospectively evaluated 91 sequentially performed magnetic resonance imaging examinations of the ankle to measure fat resembling a discrete lipoma at the medial midfoot. Each blinded reader measured the largest area of continuous subcutaneous fat in orthogonal axial, coronal craniocaudal, and coronal transverse dimensions. Patient age, sex, and study indications were also recorded. Statistical analysis was performed with R and SAS 9.4 software

Results A discrete fatty pseudolesion as defined by measuring at least 1 cm in all planes by measurements of at least two of three readers was present in 87% of cases (79 of 91). When a size criterion of 1.5 cm was used, a pseudolesion was documented in 14% of cases (13 of 91). There was a significant correlation between larger pseudolesion size and female sex in the axial plane; however, there was no correlation in the coronal craniocaudal and coronal transverse dimensions.

Conclusions Subcutaneous fat at the medial midfoot often has a mass-like appearance that could be mistaken for a lipoma. It is important to recognize this pseudolesion variant and not to confuse the imaging appearance for a discrete mass.
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Michael Ratcliffe · Aug 10, 2021

Dear Arena Colleagues,

The fatty structure identified by Strickland et al. reminded me of a similar unstructured fatty mass identified by Campanelli et al . 2011 in a similar location:

(Campanelli V, Fantini M, Faccioli N, Cangemi A, Pozzo A, Sbarbati A. Three-dimensional morphology of heel fat pad: an in vivo computed tomography study. J Anat. 2011 Nov;219(5):622-31. doi: 10.1111/j.1469-7580.2011.01420.x. Epub 2011 Aug 17. PMID: 21848602; PMCID: PMC3222841.)

The Campanelli team posited the idea that as the unstructured area of fat (located on the antero-medial side of the heel) didn't contain any of the connective septae like that of the plantar heel fat pad, this 'unstructuring' may be a 'consequence of the absence of loading during the gait cycle (given its position)'

I would be delighted to learn of any thoughts/facts you have about this structure.

Many thanks

Michael

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