Rheumatoid nodule presenting as an indeterminate soft tissue mass in the sole of the foot.

A 64-year-old lady with a background of rheumatoid arthritis presented to the foot and ankle clinic with lump underneath the sole of her foot causing significant discomfort. Examination revealed she had a swelling of the first and the second metatarsophalangeal joints. Magnetic resonance imaging revealed abnormal soft tissue thickening between the second and the third metatarsal and a single large encapsulating indeterminate soft tissue mass with a peripheral inflammatory rim. The appearance was suggestive of a malignant sarcoma rather than a rheumatoid nodule or rheumatoid tenosynovitis. The patient was referred to the regional sarcoma unit where the scans were reviewed, and a sarcoma was ruled out. The patient then underwent excision of the indeterminate soft tissue mass. Histology revealed granulomatous infiltration suggestive of a rheumatoid nodule. This has not been described previously in the literature.

Rheumatoid nodule presenting as a Morton's neuroma in the foot: An important differential diagnosis to consider.

A 51-year-old lady with a background of rheumatoid arthritis presented to the foot and ankle clinic with pain and a typical history of Morton's neuroma. Examination revealed a palpable swelling over the right foot in the third intermetatarsal space. Following failed conservative management, the patient underwent excision of the neuroma. Histology revealed of necrotizing granulomas with peripheral palisading and no evidence of features specific to a neuroma. This has rarely been described previously and supports the concept of rheumatoid synovitis and nodules producing symptoms mimicking Morton's neuroma/metatarsalgia. Level of clinical evidence: 4.

Plantar nerve neural fibrolipoma: rare neuroma arising from the plantar nerve of the heel.

Every year, as many as 2 million patients worldwide present with plantar heel pain, with men and women being affected equally. This case reports reflects upon a healthy 46-year-old female who presented with a subtype of true neoplasm called as neural fibrolipoma arising from the plantar nerve. This 17 × 7 × 11-mm painful soft tissue mass was firstly detected by USS, which showed this mass extended deep to the plantar fascia and not arising from it, hence ruling out the common misconception of plantar fibromatosis. Later, as discussed in the Yorkshire Sarcoma MDT with magnetic resonance imaging images, a malignancy was ruled out. The patient eventually opted for an excision biopsy which confirmed the neural fibrolipoma followed by an excellent outcome at a 2-year review. This case report highlights the need to consider the neural fibroplipoma as a rare case of plantar/heel pain, and excision of the lesion would provide an excellent outcome.

Managing rare fractures - a case report of an isolated avulsion fracture of the peroneus longus tendon.

Avulsion fractures of the peroneus longus tendon are seldom seen and potentially can go undiagnosed during an emergency visit. If not managed appropriately, it can lead to chronic pain and suffering. This case report presents a 55-year-old postman who was seen in the clinic complaining of persistent pain over the instep of his right foot with no history of trauma. His pain was localized to the first metatarsophalangeal joint with some radiation to the heel. Magnetic resonance imaging revealed an isolated avulsion fracture of the first metatarsal, which was initially missed on X-ray. In this case, the patient was successfully treated with a mixture of steroid and local anesthetic injections. Following our intervention, the Manchester Oxford Foot Questionnaire was reduced from 33 to 0. The goal of this article is to raise awareness of this rare finding for doctors who may face this in accident and emergency (A&E), Orthopedic clinics or at a general practice (GP) practice.