Question
In Jan 2007, I found a lump on the top of my right foot. It was slightly painful to the touch, hard, like bone and it hurt to wear shoes. At first, I thought I might have hit it on something and figured it would go away in a few days, but when it didn't, I went and saw my family doc.

My family doctor sent me through a battery of tests, xrays, bone scans, an MRI and a CT scan. They always came back inconclusive, but they agreed it was benign and it was bony and it was located on my 2nd metarsal. I was also referred to an orthopedic surgeon, one of the handful in our town. (He has a waiting list of 14 months, but because they originally thought I was dealing with cancer, I got in 6 months). I saw him in June of 2007, he said it was a bone spur type thing, and because it was causing me pain, he'd remove it. I was placed on an "urgent" wait list, and after months of begging, I finally received a surgery date of Jan 9th, 2008.

The surgery, he told me, went well. Before the surgery, he'd had suspicions that it was an osteochondroma, and he found the stalk and cartiligious cap while operating. When I awoke, the first thing he told was that it was benign and it was an osteochondroma. He explained that there was a slight chance of recurrence. I spent 5 days on bed rest, and then another two and a half weeks confined to the house on crutches.

At 13 days post op, I returned to the hospital to have my bandage and tape removed from my foot. My doctor told me it was healing well, recommended I take it easy for another week or so before I resume my regular life. I returned home, barefoot, and washed all the iodine/betadine off my foot . That's when I noticed that I still had a lump, underneath my scar, in the exact same feel and shape as the osteochondroma that had been removed. I made an appointment to see the surgeon and his receptionist got me a short appointment a week later.

The doctor felt the mass (which was surrounded by swollen and numb soft tissue, and extremely painful , much more painful then before the surgery ) and said it was a hematoma covered by scar tissue. He said it would go away shortly and if I still had a problem with it in 4 months, THEN I should come back. The biopsy came back on the mass he had removed and it confirmed an osteophyte, which he told me meant osteochondroma. I left his office in tears .

The next few months were hell. I cannot walk on my foot properly, I have to walk on the outside edges, meaning I have overturned my ankle several times now. It causes me constant pain , horrible pain. I haven't worn a shoe that covered the top of my foot since before my surgery , so I must always wear flats. The soft tissue swelling went away, but I am still numb around my toes and the base of my toes. The lightest touch on the mass causes pain , I have nearly passed out on several occasions when I have accidently knocked into something. I can barely stretch the foot and it hurts if I hit the inside of my foot on something. I walk with a limp, it's slight, but it's there. And needless to say, it did not go away like the doctor told me it would.

So in March 2008, as I approached that 4 month mark, I called and asked for an appointment with him, and the earliest appointment I got was for the beginning of August. In utter frustration, I made an appointment with my family doctor in early April. She sent me for an xray, and I went back for the results two weeks later. The xray stated that it was a bony thing, and it was larger then my xrays from before my surgery . The next day, I received a letter in the mail stating my appointment with my surgeon had been moved up to the end of May.

I went and saw my surgeon. He told me it was either a recurrence or a calcium deposit. He sent me for an urgent CT scan, which I had on June 16th. I received my results on July 21st, which stated a definite recurrence. My surgeon removed the lesion on August the 8th. However, the lump is STILL there. I have seen my surgeon twice since the surgery and he has told me it is just swelling, post surgery edema, and that he will do a CT scan in a month if it is still present. It will be present, because it is the exact same hard, bony lump that has been present since the beginning. He also told me the results of my biopsy, that it is an osteochondroma with reactive features. There were plasma cells present in the cortex?? (I don抰 remember where, it抯 something along those lines). He said it just meant my bone was irritated. Is this correct?  Because to be honest, I抦 starting to lose a little faith in him.

He took out much more bone this time, so I was non杦eight bearing for a month and then gradually worked up to lightly bearing on my heel, then my foot, then lightly walking with the crutches, etc. In total, I was on the crutches for 2 months. I am in constant pain. I can抰 walk on my foot normally, so I have had 3 serious sprains since August as I overturn my ankle quite a bit (I have to walk on the side of my foot). My most recent xrays were taken in December, and it showed the presence of the lesion again. My doctor is quite worried and is monitoring me on a six week basis. He has retired from surgery and has passed me over to a new comer (who I probably won抰 see for a year or so) and is considering referring me to someone out of town. My next appt with him is in the first days of Feb.

I'm desperate and worn down. Does anyone have any ideas what this could be? Or what I should do? Is there any chance this could be a cancerous lesion (chrondosarcoma)? Please, help me. And if you read this entire explanation, thank you so much. I pray that you might be able to give me some advice!


Answer
Hi Melissa,

Osteochondroma is a common problem and has a high recurrence rate.  Your dr removed it and sent it for pathology and that was appropriate.  When the lesion returned it was biopsied again and came back with the same diagnosis.  I believe you are just getting a recurrence of the lesion a third time.  It is possible to have osteosarcoma but your pathology was negative twice already.  I belive you have several options.  You can request that another pathologist look at the bone lesions for another opinion.  I would also consider seeing another dr. even if that means travel.

Good Luck.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com

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