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Painful overgrowth of fatty pad over plantar styloid process

Discussion in 'Foot Surgery' started by Leah Claydon, Aug 29, 2009.

  1. Leah Claydon

    Leah Claydon Active Member


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    This 24 yr old femail Cypriot patient presents with bilateral overgrowth of the fibro fatty pad that overlies the plantar aspect of the styloid process. The left foot, pictured, is considerably worse than the right and is growing steadily. Wear marks on her shoes distinctly show plantar pressure in this area. On palpation the fatty pads are smooth, non fluctuant and firm. The styloid processes themselves do not appear or feel enlarged. She doesn't participate in any strange activities that could have contributed to this lump development.

    She is having difficulty walking and feels more comfortable in a heel height of about 3-4 cm.

    She is 1.70 tall and weighs 62Kg (slim build). Her feet are boney and narrow. In relaxed stance she is mildly pronated around the subtalar joint and mid-tarsal joints. Her 4th and 5th toes are retracted. The 5th metatarsal is hypermobile. Her 4th metatarsal heads are plantar prominent and the 5th metatarsal is dorsally displaced in relation to the 3rd and 4th metatarsal head. In subtalar neutral in the forefoot is in a varus position. We've discussed footwear and orthotic options but really she is looking for a surgical solution - does anyone have any suggestions?

    Leah
     

    Attached Files:

  2. drsarbes

    drsarbes Well-Known Member

    Hi Leah:
    First........it's feMALE! haha

    Not too unusual, you'll need x-ray to see if there are accessory ossicles here or just enlarged 5th metabase (from pes cavus).
    It's also seen in Charcot's foot.

    The soft tissue mass concomitant with any bony pathology I have found more consistent with lipoma rather than fibrosis.

    If it's localized there is usually nothing that can't be removed, however, she will always have a somewhat large 5th metabase.

    Good luck
    Steve
     
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