The differential diagnosis of foot lumps: 101 cases treated surgically in North Glasgow over 4 years

Abstract

Introduction: There are a wide variety of different lesions which present as lumps of the foot. There have been very few studies which look at the presenting characteristics or the differential diagnosis of such lesions.

Patients and methods: All patients who underwent excision or biopsy of a foot lump over a period of 4 years were studied in order to determine patient demographics, presenting characteristics, diagnoses encountered and to assess the diagnostic accuracy of the surgeon.

Results: In total, 101 patients were identified. Average age was 47.3 years (range, 14-79 years); there was a marked female preponderance with 73 females and 28 males. Thirty different histological types were identified; ganglion cysts were the most commonly encountered lesions and there was only one malignant lesion encountered in this study. Only 58 out of the 101 lumps were correctly diagnosed prior to surgery. Certain lesions were more commonly encountered in specific zones of the foot.

Conclusions: We have shown that there are a wide variety of potential diagnoses which have to be considered when examining a patient with a foot lump. There is a low diagnostic accuracy for foot lumps and, therefore, surgical excision and histological diagnosis should be sought if there is any uncertainty.

Figure 1

The zones of the foot used to analyse the data as described by Kirby et al. The lines correspond to an oblique coronal plane, drawn from the mid-tarsal joint to the posterior margin of the longitudinal arch; a transverse plane, drawn from the mid-point of the metatarsal heads to the level of insertion of the Achilles tendon into the calcaneus; and a coronal plane, drawn through the metatarsophalangeal joints. These regions were numbered 1–5, to correspond to the ankle, heel, dorsum of the foot, plantar surface of the foot, and toes.

Figure 2

Number of patients by age.