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.

Angioleiomyoma-rare soft tissue tumor of the foot and ankle, review of two patients and review of the literature.

Angioleiomyomas are relatively rare benign soft tissue tumors which often occur in the extremities. The true etiology is largely unknown and is seldom associated with pain. They are rarely diagnosed preoperatively as the clinical and radiological examinations are often nonspecific and inconclusive. The patients may face a considerable delay before a specialist treatment is sought due to the varied presentation/missed diagnosis preoperatively. This delay highlights the need for better characterizing the diagnosis and treatment of angioleiomyomas in clinical setting to expand awareness of this pathology, the differential diagnosis of lower extremity soft tissue tumors and the need for ongoing publication of such case reports. We wish to present two patients who came in with foot and ankle swellings and heel pain. Post-excision, these swellings were histologically diagnosed as benign angioleiomyomas.

MRSA colonisation in patients admitted with hip fracture: implications for prevention of surgical site infection.

In a prospective study we assessed 440 patients, sequentially admitted to the trauma unit with hip fracture. Of the 403 who had a swab on admission, 5.2% (21/403) were found to be colonised with MRSA. Fifty two percent of MRSA colonised patients were admitted from their own home, 29% from residential homes and 19% from nursing homes. MRSA colonisation was found in 3.6% of patients admitted from their own home, 10.9% of residential home patients, and 17.4% of nursing home patients. A high proportion (80.9%) of colonised patients had been admitted to a hospital within the previous one year, and the high prevalence of previous hospitalisation among people from institutional care may explain the higher rates of MRSA carriage among these individuals. When a patient gives a history of hospitalisation within the previous year, it is clearly sensible to consider the use of an agent such as teicoplanin for perioperative prophylaxis.

Brachial plexus injury after anterior shoulder dislocation: a case report.

Brachial plexus injury is a rare complication of anterior dislocation of the shoulder: nine cases have been reported in the literature. We report a unique case of anterior dislocation of the shoulder with associated brachial plexus palsy involving the posterior and medial cords. This is the first reported case of such an injury. Previous case reports of brachial plexus palsy in association with anterior shoulder dislocation are reviewed. Conservative management affords good recovery from these injuries over a period of up to 18 months.