Intramuscular Glomus Tumor of Foot Presenting as Neuroma of Sural Nerve: A Case Report

Glomus tumors are benign vascular hamartomas that lie in the reticular layer as an arteriovenous anastomosis in the dermis. A glomus tumor is usually located in the subungual region of the digits. They occur more often in the hand (75%) than elsewhere and are located beneath the fingernail in 25-65% of patients. Clinical and radiological (magnetic resonance imaging [MRI]) usually clinch the diagnosis in the majority of cases. Twenty-five percent are not subungual, however, and these may pose a difficult diagnostic problem.

A 40-year-old male, a known case of cardiac disease with a pacemaker in situ, experiencing pain on the lateral aspect of the hindfoot following trauma, was diagnosed with soft tissue injury. The patient presented with persistence of pain and development of paresthesia as a new symptom over 1 year. The diagnosis of neuroma of the sural nerve was made on the premise of localized pain and paresthesia in a patient with a prior history of a blunt trauma, supported by ultrasonography. Intraoperatively, the nerve was found intact, and tumor tissue was located within the muscle, which was excised. Histopathology confirmed a glomus tumor. The patient was symptom-free on the immediate post-operative day.

Glomus tumor is a rare but important differential diagnosis for localized foot pain and must be evaluated with MRI. In cases where MRI is not feasible, the surgery must be performed keeping the option of vigilant tissue exploration to locate any lesion. Complete excision of the tumor is curative.