Statistical analysis of 307,601 tumors and other lesions of the foot.

This laboratory study is limited to lesions submitted from office procedures and makes no claims or comparison regarding statistical data from hospitals, where most malignancies are excised. This study is ongoing, and will be updated regularly to observe trends and alert practitioners to changing patterns of incidence.

Basal cell carcinoma of the sole.

Basal cell carcinoma (BCC) of the plantar surface of the foot is rare, with only 22 previously reported cases. This clinicopathologic study is based on 20 cases of BCC of the plantar surface and plantar-like surfaces from adjacent lower lateral and medial aspects of the foot, submitted to a large podiatric laboratory from 1986 through June 1992 (total specimens for this period = 518,624; total BCC of lower extremities, below knee = 53). There were 15 women and 5 men. The average patient age was 73 years, with a range from 52 to 92 years. The duration of the lesion before diagnosis was 2 months to 12 years, with an average of 2 years. Three patients had a history of trauma. Podiatric clinical diagnoses included BCC (4), SCC (3), soft tissue tumor (2), nevus (1), granuloma (1), keratosis (2), verucca (1), and psoriasis (1). Follow-up information was available on 10 patients; all were free of disease up to 64 months, with an average follow-up of 15.7 months. Three of 20 BCC showed predominant histologic patterns characteristic of fibroepithelioma of Pinkus (FEP). An additional three BCC showed focal or suggestive patterns of FEP. Fourteen tumors showed ordinary BCC histologic patterns. No multicentric-superficial or morphea like BCC were observed. The relatively high incidence of FEP in BCC of the sole correlates with abundant sweat glands and lack of hair follicles on the plantar surface, in accordance with the recent proposal that FEP derives its histologic pattern from the spread of BCC down eccrine ducts, eventually replacing them with solid strands of tumor.

Silicone elastomer microshards in fluid from a painful metatarsophalangeal implant site. A case report.

Histopathologic studies have demonstrated microshards from silicone elastomer metatarsophalangeal joint implants in adjacent tissues in a setting of chronic inflammation and in inguinal lymph nodes. Cytologic smears of synovial fluid from symptomatic implanted joints should show these refractile, nonpolarizing microshards in the reactive inflammatory context. Nonspecific enzymatic inflammatory activity contributes to further destabilization of the implants, eventuating in symptoms and signs requiring prosthesis removal. Cytopathologic examination of aspirated fluid from the vicinity of a symptomatic implanted joint demonstrates foreign body reaction to silicone elastomer, predicting a need for intervention before the local damage is severe and disabling.

Malignant eccrine neoplasms of the foot.

Eccrine cancers are uncommon, but potentially recurrent, metastatic and fatal. Rarely, they are primary foot lesions. The literature records 46 foot cases, with age and sex given for 41. Various eccrine cancer types (most on the sole), affected all races, males predominating. Average age at diagnosis was approximately 55. A podiatric facility recorded eight cases among approximately 30,000 skin biopsies, during 15 years. Seven arose in women. Five arose in the great toe area. Three are porocarcinomas. Five are "adenocarcinomas" varying in degree of differentiation. None of the eight patients presented recurrence or metastasis during follow-up 0.5-13.4 years. Of the combined 49 literature and podiatric cases, 28 (57.1%) arose in men, mostly between ages 41 and 70. Most were slow growing, long standing, and mildly symptomatic. No clinical features distinguished eccrine cancers from other pedal tumors.

Kaposi's sarcoma in the foot. A retrospective study.

Kaposi's sarcoma has been found to be present in a significant number of patients infected with HIV. A report of 162 cases of biopsied specimens has been presented with a review of previous studies. Diagnosis, cause and treatment have been discussed, leading to the conclusion that the podiatrist must be well versed in his understanding of Kaposi's sarcoma in order to recognize, treat, and alert the patient to the diagnosis of AIDS.

Immunohistochemistry in the differential diagnosis of nodular hidradenoma and glomus tumor.

The histologic distinction between nodular hidradenoma and glomus tumor is an occasional difficult diagnostic problem. Both tumors may show circumscribed aggregates of uniform epithelioid cells, a myxoid stroma, and variable numbers of blood vessels. Especially troublesome are solid cellular hidradenomas without duct-like structures and glomus tumors without a vascular pattern. To develop an immunohistochemical profile useful in this differential diagnosis, 25 selected skin tumors and four normal glomus bodies were studied with antibodies against low molecular-weight cytokeratin (CAM 5.2), epithelial membrane antigen (EMA), carcino-embryonic antigen (CEA), S-100, and vimentin (VIM). The tumors included eight unequivocal hidradenomas, seven unequivocal glomus tumors, and 10 histologically equivocal cases, originally diagnosed as glomus tumors. In all unequivocal glomus tumors and glomus bodies, only VIM was positive. Of the eight unequivocal hidradenomas, three were positive for CAM 5.2, EMA, CEA, S-100, and VIM; two for CAM 5.2 only; one for CAM 5.2, EMA, and S-100; one for CAM 5.2, EMA, and CEA; and one for CEA only. In the histologically equivocal cases, eight were positive for VIM only, characteristic of glomus tumor; and two were positive for CAM 5.2, EMA, CEA, S-100, and VIM, and were reclassified as hidradenomas. The study suggests that morphologic criteria may not always accurately differentiate between hidradenoma and glomus tumor and that in equivocal cases immunohistochemistry may be useful in the differential diagnosis.

Tumors of the heel.

We have attempted to show a correlation between heel pain and tumors and tumor-like conditions. The anatomy and size of the calcaneus predisposes it to increased incidence of trauma. Furthermore, the increased vascularity of the heel versus other areas of the foot may contribute to a higher incidence of both local and metastatic tumors. Most tumors and tumor-like conditions initially present with pain as the patient's primary complaint. Therefore, any complaint of heel pain must be thoroughly evaluated and treated. Accordingly, when biopsy or excision is necessary, the surgeon must plan his approach while considering the unique position and anatomic properties of the calcaneus.

Stress fracture of the first metatarsal after Keller bunionectomy.

Complications following the Keller bunionectomy procedure are reviewed. The authors particularly reference metatarsal stress fractures. They describe a first metatarsal fracture sustained postoperatively in a 58-year-old diabetic patient.

Kaposi's sarcoma of the foot. A review and report of 156 cases.

The authors identify the incidence of Kaposi's sarcoma in the foot, and discuss the increasing incidence of AIDS-related cases, and the increasing chance of mortality when this lesion is seen in patients under the age of 50.

Modified Austin bunionectomy with single screw fixation: a comparison study.

The authors present a new modification of the Austin bunionectomy with single 2.7-mm. cortical screw fixation, and a comparison study with the standard osteotomy fixation using a single Kirschner wire. The results include subjective postoperative evaluation as well as objective radiographic analysis. Suggestions are made that this type of procedure is indeed a viable alternative in a large patient population suffering from hallux abducto valgus deformities.

Lower extremity manifestations of phenylketonuria.

Phenylketonuria is an inborn error of metabolism with its most notable characteristic being that of mental retardation. The literature describing this disorder has been reviewed to identify the abnormal lower extremity findings in affected individuals. The dermatologic, osteologic, and neuromuscular systems were all found to be involved. Lower extremity physical examinations were then performed on nine phenylketonuric adults. It was determined that several of the reported manifestations of phenylketonuria were similarly evident in these individuals as well as the presence of additional lower extremity pathology not previously documented. However, the conclusion was made that all findings, past and present, were variable and that no consistent manifestation was apparent.

Myofascial pain syndromes and their effect on the lower extremities.

Myofascial pain syndrome is an entity with which every podiatrist should be familiar. These disorders are usually the result of acute or chronic injury and are characterized by the presence of trigger areas and symptom complexes that have definite patterns. Once these patterns have been learned, the sources of pain can be readily predicted. Most of these conditions can be effectively treated in the podiatrist's office by local block techniques and/Or by application of Fluori-Methane spray. It is important to consult the appropriate medical specialist for diagnostic confirmation or for aid in treatment if uncertainty exists. Treatment regimens in this group of syndromes are based on the notion that in these disorders there is a self-sustaining cycle of pain-spasm-pain persisting after the precipitating cause has disappeared, which may be permanently abolished by interruption of the reflex mechanisms. In order to produce optimal results, the trigger area must be accurately located and treatment directed toward its elimination. Physical therapy and active exercise are necessary adjuncts to local blocks. Not all patients respond, and in many the response is slow, incomplete, and/or only temporary, but there are those in whom these simple measures provide relief of pain and disability in a manner as dramatic as one is likely to encounter in practice.

Complications of Keller bunionectomy and Keller with Swanson hemi-implant.

The authors compare results of hallux valgus correction by the Keller bunionectomy and by the Swanson hemi-implant. The Keller bunionectomy, which is simple to perform and usually gives a satisfactory cosmetic result, is still commonly used although many authors believe that implant arthroplasty is now the procedure of choice. The primary cause of complications seen after the Keller bunionectomy is lack of stability, whereas the largest cause of failure in implant arthroplasty is probably infection.