Author: Keri Denay, MD

Patient Presentation:
Patient is a forty-five year-old man with a foot mass.

History:
Patient is a rec league basketball player with a past medical history notable only for current tobacco abuse who presented with a complaint of foot mass. The mass had been present on the dorsum of the left mid-foot for about a year, initially noticed after a basketball game. He does not recall any injury or trauma. The mass had continued to grow until the last month when its growth rate seemed to have stabilized. He feels the color of the mass changes based on the surrounding temperature - it seems to be more purple if cold and red if warm or hot. He does have an intermittent, fleeting, and sharp pain in the area. He is unaware of any particular aggravating or alleviating factors. He has been able to continue to play basketball but has found it difficult to get his shoes to fit correctly. He has not been experiencing any fever, chills, weight loss, night sweats, or drainage from the site. He has never had anything like this before. He denies any personal or family hisotry of any bone, joint, muscle, or rheumatologic processes.

Physical Exam:
Patient appeared older than stated age male in no acute distress. Vitals signs were stable and he was afebrile. Upon removal of his shoe, the patient had a large, protruding mass on the dorsum of the midfoot, measuring 5 x 6 centimeters in diameter with elevation of 2-3 centimeters above the surface of the foot. The area was slightly ecchymotic and had some surface telangiectasias. He had full range of motion of the ankle and all toes without pain. Full resisted strength testing without pain. With palpation, the patient has slightly decreased sensation with light touch over the mass only. He did have < 2 second capillary refill of all toes. The mass felt tense and was mildly tender to palpation. No warmth was appreciated. It felt to be slightly mobile and a septum was felt to be present internally. No open wounds or lesions seen. The remainder of his exam was non-contributory. Case Photo #1 , Case Photo #2 , Case Photo #3

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