A Rare Case of Plantar Intramuscular Hemangioma: Diagnostic Challenges and Surgical Management in a 34-Year-Old Female

Abstract

Hemangiomas are benign tumors of the soft tissues, with intramuscular hemangiomas (IMHs) being an exceptionally rare subtype. Intramuscular hemangiomas (IMHs) typically occur in younger adults and often involve the lower limbs, particularly the thigh. Localization in the foot is exceedingly rare. These tumors are often asymptomatic but may present with pain and swelling, especially during activity, posing diagnostic challenges. A 34-year-old female presented with a one-year history of progressive, persistent pain on the plantar side of her left foot. The pain, described as a deep ache exacerbated by weight-bearing activities, led to gait impairment and limping. Physical examination revealed significant tenderness but no swelling, erythema, or muscle atrophy. The X-ray reveals no abnormalities, prompting further evaluation with MRI. Imaging revealed an ill-defined vascular lesion involving the flexor digitorum longus and brevis tendons and adjacent muscles. Surgical excision was performed, and histopathology confirmed a cavernous hemangioma. The patient's postoperative course was uneventful, with immediate pain relief and restored function. Intramuscular hemangiomas (IMHs) are rare, locally aggressive benign tumors that are often misdiagnosed due to their nonspecific symptoms and rarity, particularly in the plantar region. Imaging, particularly MRI, plays a pivotal role in identifying characteristic features and guiding management. Histological confirmation remains essential for diagnosis. While surgical excision is the preferred treatment for symptomatic intramuscular hemangiomas (IMHs), recurrence and functional impairment remain concerns, underscoring the importance of proper diagnosis and intervention. This case emphasizes the importance of recognizing rare presentations of intramuscular hemangiomas (IMHs), such as in the plantar foot. A multidisciplinary approach, imaging, and histological analysis are crucial for accurate diagnosis and management. Long-term follow-up is necessary to monitor recurrence and ensure functional recovery.