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A 72 year old male attended our clinic today with a very interesting red painless plantar lump, with overlying swelling sub 3,4,5 metatarsal base, extending proximally about 7cm, approximate protrusion of lump 1cm.

Foot otherwise appeared moderately swollen, with a venous ulceration located proximally on tibia region. 5 degree celcius difference between right and left foot in region of lump. History of 3 months of quadrupled normal prescribed dosage of cortisone due to misreading of packaging which has just decreased to a normal dosage of 4mg (abnormal dose was 20mg).

Hx of vascular disease, 2 stents and awaiting balloon angioplasty. No neuropathy to mask pain.

Any ideas for diagnosis? We are not sure how to manage this one, should we obtain ultrasound scan?

 

Any history of Diabetes or neuropathy? It could be a Charcot Neuroarthropathy. I suggest an X-ray, and if confirmed off-load with a total contact cast (bi-valve because of the venous ulcer) or cam walker and monitor the temperature. Try and see if you can get a bone scan and a pemidronate infusion.
Hope that helps!
Helen

 

Thanks Helen for your reply. There is no history of Diabetes or neuropathy which is why this is such a curious case. We could get a bone scan,yes, but it might just be soft tissue involvement. Could there be any link to the excessvie doses of Cortisone?
Once again, there is NO PAIN associated with this red, hot, swollen lump.
Thanks
Hazel & Thea

 

Hi,
Have the foot scanned and obtain a Radiologist Report. I saw something like this several years ago which turned out to be a malignancy (secondary).