Surgical Management of Arteriovenous Malformation in the Foot: A Case Study

Arteriovenous malformations are frequently found in the head and neck, and are occasionally associated with congenital syndromes. They are rarely reported in the foot and ankle; however, when encountered in these particular locations, they may become painful and interfere with ambulation. Because of the lack of literature on pedal arteriovenous malformations, they remain enigmatic when encountered clinically. They form as a result of atypical development of the vascular system during embryogenesis. The identification, diagnosis, and treatment of an arteriovenous malformation can be challenging, because it may present similarly to more frequent soft-tissue pathologies in podiatric practice. These include fibroma, lipoma, ganglion cyst, or proteinaceous cyst. They have unpredictable behavior and a high recurrence rate. Failure to recognize and treat an arteriovenous malformation appropriately could result in ulceration, hemorrhage, and amputation. The identification and diagnosis must be accompanied with a full vascular work-up to determine the magnitude, flow, and extent of the lesion. After vascular work up, conservative, and surgical treatment options can be explored. This is an unusual case report of an arteriovenous malformation of the plantar foot that was previously misdiagnosed, and later presented to our facility for a second opinion. The steps taken for identification, diagnosis, and treatment are discussed along with surgical technique for excision of an arteriovenous malformation with successful outcome at 1 year follow-up. This case report will provide clinicians with armamentarium for diagnosis, workup, and treatment, when considering arteriovenous malformation in the differential diagnosis.