Massive medial plantar Enchondroma Presenting with Toe Numbness: A Rare Case report

Massive medial plantar Enchondroma Presenting with Toe Numbness: A Rare Case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Massive medial plantar Enchondroma Presenting with Toe Numbness: A Rare Case report Morteza Gholipour, Arman Namazi, Seyyedeh Reyhaneh Sadr, Fatemeh Abbasi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7171673/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Enchondroma is a rare, slow-growing benign tumor that arises from the remnants of growth plate cartilage and can occur in soft tissue. One of the rare sites where enchondroma is seen is on the plantar surface of the foot. Our patient is a 75-year-old woman with diabetes and controlled blood pressure who has been suffering from the lesion for 2 years with pain and discomfort. Incisional surgery was performed on the medial plantar surface of the foot and the mass was successfully removed. The appearance of the mass and pathological tests confirmed the mass to be an enchondroma. The patient's symptoms improved over time and now she reports normal sensation and movement of the foot without any problems. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Enchondromas are benign neoplasms arising from residual cartilaginous tissue left behind during bone formation via endochondral ossification [1,2]. These tumors account for 10–25% of benign bone neoplasms and are among the most common benign tumors of bone [1,3]. Most enchondromas are asymptomatic and often incidentally found during imaging for unrelated conditions [4,5]. However, when they grow in specific locations or reach large sizes, they may cause localized pain, swelling, or even neurologic symptoms due to adjacent structure compression [6,7]. While enchondromas frequently occur in the small bones of the hands and feet—particularly the phalanges—they are rarely found in soft tissues such as the plantar region [8,9]. Even more rarely do they present with neurologic symptoms such as numbness, especially on the medial aspect of the hallux (big toe), which is typically innervated by the medial plantar nerve, a branch of the tibial nerve [10]. The differential diagnosis for palpable masses in the plantar region includes ganglion cysts, neurilemmomas, plantar fibromatosis, tarsal tunnel syndrome, and lipomas [11,12]. Due to their usual intraosseous presentation, enchondromas are rarely considered as a possible diagnosis in soft tissue masses of the foot [9,13]. We report a rare case of a medial plantar enchondroma in a 75-year-old woman who presented with chronic pain and medial hallux numbness. This case highlights the importance of including benign cartilaginous tumors in the differential diagnosis of plantar foot lesions—particularly when neurological symptoms are present. Case report A 75-year-old female patient came in with a chief complaint of right foot plantar pain with numbness on the inside of the great toe, an issue she has had over the past 2 years. It has become increasingly harder to walk and bear weight because of the pain, which started gradually worsening over time. The patient does not recall having any ankle or foot problems in the past, nor does she recall any trauma to the area. Assumptions were made about the conservative approach having failed due to the removal of the thickened skin laundry lesions and offloading pressure not relieving them. There is a medical history of type II diabetes and hypertension that are managed with Metformin 500 mg TDS, Valsartan 80 mg OD, respectively. There was no indication of a smoking or drinking habit and no significant drug allergies or other pertinent medical history were provided. The examination showed the lesions mentioned above. Thickened skin around the arch of the foot borders with the heel has formation of a painful movable mass of approximately 2cm, which is hard to the touch and exhibits pain upon palpation, situated above the arch in the medial foot region. There was no sign of redness or warmth and no observing of the skin showed no signs of ulceration (figure.1). Inspection of the ankle, subtalar and metatarsophalangeal joints of the right foot revealed complete non painful range of motion. During neurological evaluation, hypesthesia to light touch was noted on the medial aspect of the hallux while motor strength and reflexes were normal. All basic laboratory investigations together with complete blood count, inflammatory markers, and metabolic panel, were all in normal ranges. During evaluation, there was well defined lobulated soft tissue mass in the medial plantar region consistent with a cartilage lesion noted on plain X-ray and MRI (Fig. 2 ). It appeared to be an enchondroma due to lack of any overlying bone surface destruction, and no reactive periosteal change. The mass compressing the nerve and lack of significant conservative treatment response led the physician to choose surgical excision. The mass was excised using a plantar curvilinear approach under local anesthesia while the patient was in the supine position (Fig. 3 ). With the patient in supine position and her foot draped in sterile fashion, incision was made longitudinally from just beneath the medial malleolus toward the plantar surface of the foot. Great attention was paid to ensure complete removal of the cartilaginous mass through careful dissection. The growth showed characteristics typical of an enchondroma since it was well-defined and non-adherent to the surroundings tissues. The mass was of approximately 3 × 2.5 × 2 cm (Fig. 4 ) and was sent to the pathology laboratory for evaluation. Her recovery after surgery was smooth and her sensory problems improved with time. In this patient, six months after the surgical excision of the enchondroma, she has returned to her normal daily activities. She has not experienced any postoperative complications such as surgical site infections or recurrence. Sensation in the affected area has completely resolved and she is pain free, with full range of motion in her foot joints. Discussion Enchondromas, being benign tumors of cartilage, arise usually in the medullary cavities of bones that form by endochondral ossification[1,4]. Their intraosseous occurrence in the small bones of the hands and feet is well known, but extension into soft tissues—particularly the plantar region—is extremely rare [9,13]. Symptomatic presentation, especially involving neurological symptoms, is even less common [6,8].On the contrary, the case we present here describes an extremely rare occurrence of a giant medial plantar enchondroma presenting symptomatically with neurological complications, thus offering a diagnostic, clinical, and therapeutic conundrum. Enchondromas of the foot have been well-described, but those extending into the plantar soft tissues or presenting with neurological impairment are rare to the point of being almost unknown. The medial plantar nerve is a terminal branch of the tibial nerve that supplies the medial plantar surface of the foot, including the medial hallux. When subjected to chronic compression or irritation, the nerve can cause sensory disturbances like numbness and tingling or painful sensations and may, in some instances, cause motor weakness [5,10,14]. In this case, the numbness lasting for over two years strongly speaks of a slow-growing lesion compressing the nerve or its branches gradually. The differential diagnoses of a firm, mobile non-inflammatory mass in the plantar region range from lipomas to fibromas, neurilemmomas, plantar fibromatosis, tarsal tunnel syndrome, ganglion cysts, and other benign or malignant soft tissue tumors [11,12]. Most of such lesions lie in soft tissue and are not (primary) bone pathologies. It is seldom that enchondroma gets entertained as a diagnostic possibility in such anatomical location, thereby making proper diagnosis delayed, as is in this case. Enchondromas are rarely suspected in soft tissue lesions of the foot due to their predominantly intraosseous nature [13]. MRI remains the most sensitive imaging modality for such lesions, often showing a lobulated, well-demarcated mass with typical cartilage signal characteristics: low T1 and high T2 signal with internal calcifications [15,16]. Imaging, MRI especially, is of paramount importance in the characterization of soft tissue masses in the foot. Enchondromas appear as a solitary, well-demarcated, lobulated lesion, with low signal intensity on T1-weighted images and bright on T2-weighted images with possible internal calcifications [7]. CT or radiographs can confirm the cartilaginous nature and be used to look for cortical involvement or matrix mineralization. The glandular tumor was proposed following imaging studies in spite of negative laboratory parameters in this case. Histopathologic confirmation is essential to rule out low-grade chondrosarcoma, especially in large or atypical lesions [8,17]. In the case of symptomatic enchondromas, surgical excision is the treatment method when neurological compromise or malignant transformation is impending, though rare in a solitary lesion. To confirm the diagnosis and to rule out low-grade chondrosarcoma, histopathological studies are imperative [18]. In an elderly population, surgical risk, comorbidities, and functional status of the patient have to be given importance if a surgical intervention is considered. Complete removal typically resolves symptoms, as seen in this case [19] This case highlights the importance of thinking about rarer entities such as an enchondroma while making a differential diagnosis of any chronic plantar foot mass, especially if sensory disturbances are involved. It additionally brings to the fore the need for thorough clinical evaluation and further imaging to reach precise diagnosis, particularly when the lesion occurs at unusual sites and mimics more common soft-tissue masses. Declarations Funding Declaration : We had no funding for this project. Clinical trial number : not applicable. Conflict of Interest: The authors state that they have no conflicts of interest concerning the publication of this case report. Ethics and Consent to Participate declarations: The patient included in the case report provided informed consent for participation in this study in accordance with institutional guidelines. Ethics approval was not required for this type of descriptive case report article. Consent to Publish declaration: Written informed consent was obtained from the patient for publication of the clinical details and associated radiological images. Availability of data and materials: No datasets were generated or analysed during the current study. All relevant information (including clinical images) is included in the article. Author Contribution F.A, M.Gh, S.R.S and A.N wrote the main manuscript. F.A and M.Gh prepared figures and tables.All authors reviewed the manuscript. References Murphey MD, et al. Enchondroma and chondrosarcoma: radiologic-pathologic correlation. Radiographics. 2000;20(5):1257–1281. Bloem JL, Mulder JD. Tumors and tumorlike lesions of bone. In: Resnick D, editor. Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia: WB Saunders; 2002. Kransdorf MJ, et al. Imaging of cartilaginous tumors. Radiol Clin North Am. 1993;31(2):299–314. Matsumoto K, Hukuda S, Ishizawa M, Chano T, Okabe H. MRI of benign cartilaginous tumors of the extremities. Clin Imaging. 1998;22(3):171–176. Standring S, ed. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Elsevier; 2015. Neary D, et al. Tumors and tumorlike lesions of the foot and ankle. Radiol Clin North Am. 2008;46(6):1093–1103. Murphey MD, et al. Imaging of cartilaginous bone tumors: radiologic-pathologic correlation. Radiographics. 2003;23(5):1245–1278. Unni KK, Inwards CY. Dahlin’s Bone Tumors: General Aspects and Data on 10,165 Cases. 6th ed. Lippincott Williams & Wilkins; 2010. Houdek MT, et al. Cartilage tumors of the foot and ankle: diagnosis and management. Foot Ankle Int. 2015;36(9):1012–1020. Standring S, ed. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Elsevier; 2015. Neary D, et al. Tumors and tumorlike lesions of the foot and ankle. Radiol Clin North Am. 2008;46(6):1093–1103. Bocchino A, et al. Soft tissue tumors of the foot and ankle: review of imaging features. Eur J Radiol. 2018;101:112–122. Okcu G, et al. Cartilaginous tumors of the foot: a diagnostic dilemma. J Foot Ankle Surg. 2010;49(2):162–167. Dellon AL, et al. Medial plantar neuropathy: etiology, diagnosis, and treatment. J Am Podiatr Med Assoc. 1994;84(12):618–623. Resnick D. Diagnosis of Bone and Joint Disorders. 5th ed. Philadelphia: WB Saunders; 2007. Sundaram M, McGuire MH, Schajowicz F. Soft-tissue lesions mimicking bone tumors: imaging findings. AJR Am J Roentgenol. 1992;158(4):811–815. Bertoni F, et al. Cartilage tumors of the foot: clinical-pathologic review of 45 cases. Skeletal Radiol. 1997;26(7):377–383. Koutserimpas C, et al. Rare benign soft tissue tumors of the foot: a diagnostic challenge. J Orthop Case Rep. 2020;10(2):18–22. Aoki J, et al. MR imaging of cartilaginous tumors with pathologic correlation. Radiographics. 2004;24(5):1437–1452. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7171673","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":507643680,"identity":"f870e5d1-1f43-488d-b63d-a2a5012eb442","order_by":0,"name":"Morteza Gholipour","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Morteza","middleName":"","lastName":"Gholipour","suffix":""},{"id":507643681,"identity":"3918873c-80a8-43fa-8db8-35f8672616bf","order_by":1,"name":"Arman Namazi","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Arman","middleName":"","lastName":"Namazi","suffix":""},{"id":507643682,"identity":"3b2f847c-5425-4137-aa8f-7198af9f7d8f","order_by":2,"name":"Seyyedeh Reyhaneh Sadr","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Seyyedeh","middleName":"Reyhaneh","lastName":"Sadr","suffix":""},{"id":507643683,"identity":"0e48fae2-9fc7-40f2-af2e-e370262d9177","order_by":3,"name":"Fatemeh Abbasi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYBACNgkeIGnAwMDe3tj4IKECyGFmbsCrhR+mhefM4cMGH86AtDDi1yI5gwfC4LmRliY5sw3EJKDF4HbvwY8/ChgSexhyDKR559VG87cDtfyo2IZby51zydI8BiAtZwyMebcdz51xmLGBsefMbdxabgANB/rF2J6xxyCZd9ux3AagFmbGNtxa7G/kGP/8AdTCw8xjcJh3zrHc+YS0AG0xkwA6TI6HjS2xcWZDTe4GglrunEuz5jGQkOPhYT7M8OHYgdyNQC0H8frldu/hmz/+2PDwyD9s/5FQU5c77/zhgw9+VODWAgUSMMZhMHmAkHpkUEeK4lEwCkbBKBghAABJ81woCSKrvAAAAABJRU5ErkJggg==","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Abbasi","suffix":""}],"badges":[],"createdAt":"2025-07-20 20:23:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7171673/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7171673/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90543439,"identity":"0ff4a1d7-2289-4d1d-a2bf-dfe3e294aba5","added_by":"auto","created_at":"2025-09-04 00:12:42","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":139380,"visible":true,"origin":"","legend":"\u003cp\u003eright foot examination\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7171673/v1/0dfaffa450d2c84a6e17375a.jpeg"},{"id":90543443,"identity":"411d21fa-831d-4ed4-ad3b-91d08c960154","added_by":"auto","created_at":"2025-09-04 00:12:42","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":307748,"visible":true,"origin":"","legend":"\u003cp\u003eA : Right foot MRI pictures\u003c/p\u003e\n\u003cp\u003eB. Lateral radiograph of the right Foot.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7171673/v1/49828b68d30cffffc2d3ca14.jpeg"},{"id":90543441,"identity":"fbfc0350-6e4e-4dd0-b0d4-82f55e53858b","added_by":"auto","created_at":"2025-09-04 00:12:42","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":90065,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7171673/v1/9049c0f808b560fc6fe0f493.jpeg"},{"id":90543438,"identity":"780a9d4c-a788-41de-aee3-0b109f017650","added_by":"auto","created_at":"2025-09-04 00:12:42","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":90329,"visible":true,"origin":"","legend":"\u003cp\u003eexcised enchonreal mass\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7171673/v1/cea68dc8ea5ef4ab39868eaf.jpeg"},{"id":91848005,"identity":"c7b23d22-ef24-42d3-b07b-91310a378ca4","added_by":"auto","created_at":"2025-09-22 10:31:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":953831,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7171673/v1/a5ec14bc-ca16-4ceb-81e6-8d4712122b10.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Massive medial plantar Enchondroma Presenting with Toe Numbness: A Rare Case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEnchondromas are benign neoplasms arising from residual cartilaginous tissue left behind during bone formation via endochondral ossification [1,2]. These tumors account for 10\u0026ndash;25% of benign bone neoplasms and are among the most common benign tumors of bone [1,3]. Most enchondromas are asymptomatic and often incidentally found during imaging for unrelated conditions [4,5]. However, when they grow in specific locations or reach large sizes, they may cause localized pain, swelling, or even neurologic symptoms due to adjacent structure compression [6,7].\u003c/p\u003e\u003cp\u003eWhile enchondromas frequently occur in the small bones of the hands and feet\u0026mdash;particularly the phalanges\u0026mdash;they are rarely found in soft tissues such as the plantar region [8,9]. Even more rarely do they present with neurologic symptoms such as numbness, especially on the medial aspect of the hallux (big toe), which is typically innervated by the medial plantar nerve, a branch of the tibial nerve [10].\u003c/p\u003e\u003cp\u003eThe differential diagnosis for palpable masses in the plantar region includes ganglion cysts, neurilemmomas, plantar fibromatosis, tarsal tunnel syndrome, and lipomas [11,12]. Due to their usual intraosseous presentation, enchondromas are rarely considered as a possible diagnosis in soft tissue masses of the foot [9,13].\u003c/p\u003e\u003cp\u003eWe report a rare case of a medial plantar enchondroma in a 75-year-old woman who presented with chronic pain and medial hallux numbness. This case highlights the importance of including benign cartilaginous tumors in the differential diagnosis of plantar foot lesions\u0026mdash;particularly when neurological symptoms are present.\u003c/p\u003e"},{"header":"Case report","content":"\u003cp\u003eA 75-year-old female patient came in with a chief complaint of right foot plantar pain with numbness on the inside of the great toe, an issue she has had over the past 2 years. It has become increasingly harder to walk and bear weight because of the pain, which started gradually worsening over time. The patient does not recall having any ankle or foot problems in the past, nor does she recall any trauma to the area. Assumptions were made about the conservative approach having failed due to the removal of the thickened skin laundry lesions and offloading pressure not relieving them. There is a medical history of type II diabetes and hypertension that are managed with Metformin 500 mg TDS, Valsartan 80 mg OD, respectively. There was no indication of a smoking or drinking habit and no significant drug allergies or other pertinent medical history were provided.\u003c/p\u003e\u003cp\u003eThe examination showed the lesions mentioned above. Thickened skin around the arch of the foot borders with the heel has formation of a painful movable mass of approximately 2cm, which is hard to the touch and exhibits pain upon palpation, situated above the arch in the medial foot region. There was no sign of redness or warmth and no observing of the skin showed no signs of ulceration (figure.1).\u003c/p\u003e\u003cp\u003eInspection of the ankle, subtalar and metatarsophalangeal joints of the right foot revealed complete non painful range of motion.\u003c/p\u003e\u003cp\u003eDuring neurological evaluation, hypesthesia to light touch was noted on the medial aspect of the hallux while motor strength and reflexes were normal. All basic laboratory investigations together with complete blood count, inflammatory markers, and metabolic panel, were all in normal ranges. During evaluation, there was well defined lobulated soft tissue mass in the medial plantar region consistent with a cartilage lesion noted on plain X-ray and MRI (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). It appeared to be an enchondroma due to lack of any overlying bone surface destruction, and no reactive periosteal change.\u003c/p\u003e\u003cp\u003eThe mass compressing the nerve and lack of significant conservative treatment response led the physician to choose surgical excision. The mass was excised using a plantar curvilinear approach under local anesthesia while the patient was in the supine position (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). With the patient in supine position and her foot draped in sterile fashion, incision was made longitudinally from just beneath the medial malleolus toward the plantar surface of the foot. Great attention was paid to ensure complete removal of the cartilaginous mass through careful dissection.\u003c/p\u003e\u003cp\u003eThe growth showed characteristics typical of an enchondroma since it was well-defined and non-adherent to the surroundings tissues. The mass was of approximately 3 \u0026times; 2.5 \u0026times; 2 cm (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e) and was sent to the pathology laboratory for evaluation.\u003c/p\u003e\u003cp\u003eHer recovery after surgery was smooth and her sensory problems improved with time. In this patient, six months after the surgical excision of the enchondroma, she has returned to her normal daily activities. She has not experienced any postoperative complications such as surgical site infections or recurrence. Sensation in the affected area has completely resolved and she is pain free, with full range of motion in her foot joints.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEnchondromas, being benign tumors of cartilage, arise usually in the medullary cavities of bones that form by endochondral ossification[1,4]. Their intraosseous occurrence in the small bones of the hands and feet is well known, but extension into soft tissues\u0026mdash;particularly the plantar region\u0026mdash;is extremely rare [9,13]. Symptomatic presentation, especially involving neurological symptoms, is even less common [6,8].On the contrary, the case we present here describes an extremely rare occurrence of a giant medial plantar enchondroma presenting symptomatically with neurological complications, thus offering a diagnostic, clinical, and therapeutic conundrum.\u003c/p\u003e\u003cp\u003eEnchondromas of the foot have been well-described, but those extending into the plantar soft tissues or presenting with neurological impairment are rare to the point of being almost unknown. The medial plantar nerve is a terminal branch of the tibial nerve that supplies the medial plantar surface of the foot, including the medial hallux. When subjected to chronic compression or irritation, the nerve can cause sensory disturbances like numbness and tingling or painful sensations and may, in some instances, cause motor weakness [5,10,14]. In this case, the numbness lasting for over two years strongly speaks of a slow-growing lesion compressing the nerve or its branches gradually.\u003c/p\u003e\u003cp\u003eThe differential diagnoses of a firm, mobile non-inflammatory mass in the plantar region range from lipomas to fibromas, neurilemmomas, plantar fibromatosis, tarsal tunnel syndrome, ganglion cysts, and other benign or malignant soft tissue tumors [11,12]. Most of such lesions lie in soft tissue and are not (primary) bone pathologies. It is seldom that enchondroma gets entertained as a diagnostic possibility in such anatomical location, thereby making proper diagnosis delayed, as is in this case. Enchondromas are rarely suspected in soft tissue lesions of the foot due to their predominantly intraosseous nature [13].\u003c/p\u003e\u003cp\u003eMRI remains the most sensitive imaging modality for such lesions, often showing a lobulated, well-demarcated mass with typical cartilage signal characteristics: low T1 and high T2 signal with internal calcifications [15,16]. Imaging, MRI especially, is of paramount importance in the characterization of soft tissue masses in the foot. Enchondromas appear as a solitary, well-demarcated, lobulated lesion, with low signal intensity on T1-weighted images and bright on T2-weighted images with possible internal calcifications [7]. CT or radiographs can confirm the cartilaginous nature and be used to look for cortical involvement or matrix mineralization. The glandular tumor was proposed following imaging studies in spite of negative laboratory parameters in this case. Histopathologic confirmation is essential to rule out low-grade chondrosarcoma, especially in large or atypical lesions [8,17].\u003c/p\u003e\u003cp\u003eIn the case of symptomatic enchondromas, surgical excision is the treatment method when neurological compromise or malignant transformation is impending, though rare in a solitary lesion. To confirm the diagnosis and to rule out low-grade chondrosarcoma, histopathological studies are imperative [18]. In an elderly population, surgical risk, comorbidities, and functional status of the patient have to be given importance if a surgical intervention is considered. Complete removal typically resolves symptoms, as seen in this case [19]\u003c/p\u003e\u003cp\u003eThis case highlights the importance of thinking about rarer entities such as an enchondroma while making a differential diagnosis of any chronic plantar foot mass, especially if sensory disturbances are involved. It additionally brings to the fore the need for thorough clinical evaluation and further imaging to reach precise diagnosis, particularly when the lesion occurs at unusual sites and mimics more common soft-tissue masses.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e: \u0026nbsp;We had no funding for this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e The authors state that they have no conflicts of interest concerning the publication of this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics and Consent to Participate declarations:\u003c/strong\u003e The patient included in the case report provided informed consent for participation in this study in accordance with institutional guidelines. Ethics approval was not required for this type of descriptive case report article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration:\u003c/strong\u003e Written informed consent was obtained from the patient for publication of the clinical details and associated radiological images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eNo datasets were generated or analysed during the current study. All relevant information (including clinical images) is included in the article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eF.A, M.Gh, S.R.S and A.N wrote the main manuscript. F.A and M.Gh prepared figures and tables.All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMurphey MD, et al. Enchondroma and chondrosarcoma: radiologic-pathologic correlation. Radiographics. 2000;20(5):1257\u0026ndash;1281.\u003c/li\u003e\n\u003cli\u003eBloem JL, Mulder JD. Tumors and tumorlike lesions of bone. In: Resnick D, editor. Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia: WB Saunders; 2002.\u003c/li\u003e\n\u003cli\u003eKransdorf MJ, et al. Imaging of cartilaginous tumors. Radiol Clin North Am. 1993;31(2):299\u0026ndash;314.\u003c/li\u003e\n\u003cli\u003eMatsumoto K, Hukuda S, Ishizawa M, Chano T, Okabe H. MRI of benign cartilaginous tumors of the extremities. Clin Imaging. 1998;22(3):171\u0026ndash;176.\u003c/li\u003e\n\u003cli\u003eStandring S, ed. Gray\u0026rsquo;s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Elsevier; 2015.\u003c/li\u003e\n\u003cli\u003eNeary D, et al. Tumors and tumorlike lesions of the foot and ankle. Radiol Clin North Am. 2008;46(6):1093\u0026ndash;1103.\u003c/li\u003e\n\u003cli\u003eMurphey MD, et al. Imaging of cartilaginous bone tumors: radiologic-pathologic correlation. Radiographics. 2003;23(5):1245\u0026ndash;1278.\u003c/li\u003e\n\u003cli\u003eUnni KK, Inwards CY. Dahlin\u0026rsquo;s Bone Tumors: General Aspects and Data on 10,165 Cases. 6th ed. Lippincott Williams \u0026amp; Wilkins; 2010.\u003c/li\u003e\n\u003cli\u003eHoudek MT, et al. Cartilage tumors of the foot and ankle: diagnosis and management. Foot Ankle Int. 2015;36(9):1012\u0026ndash;1020.\u003c/li\u003e\n\u003cli\u003eStandring S, ed. Gray\u0026rsquo;s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Elsevier; 2015.\u003c/li\u003e\n\u003cli\u003eNeary D, et al. Tumors and tumorlike lesions of the foot and ankle. Radiol Clin North Am. 2008;46(6):1093\u0026ndash;1103.\u003c/li\u003e\n\u003cli\u003eBocchino A, et al. Soft tissue tumors of the foot and ankle: review of imaging features. Eur J Radiol. 2018;101:112\u0026ndash;122.\u003c/li\u003e\n\u003cli\u003eOkcu G, et al. Cartilaginous tumors of the foot: a diagnostic dilemma. J Foot Ankle Surg. 2010;49(2):162\u0026ndash;167.\u003c/li\u003e\n\u003cli\u003eDellon AL, et al. Medial plantar neuropathy: etiology, diagnosis, and treatment. J Am Podiatr Med Assoc. 1994;84(12):618\u0026ndash;623.\u003c/li\u003e\n\u003cli\u003eResnick D. Diagnosis of Bone and Joint Disorders. 5th ed. Philadelphia: WB Saunders; 2007.\u003c/li\u003e\n\u003cli\u003eSundaram M, McGuire MH, Schajowicz F. Soft-tissue lesions mimicking bone tumors: imaging findings. AJR Am J Roentgenol. 1992;158(4):811\u0026ndash;815.\u003c/li\u003e\n\u003cli\u003eBertoni F, et al. Cartilage tumors of the foot: clinical-pathologic review of 45 cases. Skeletal Radiol. 1997;26(7):377\u0026ndash;383.\u003c/li\u003e\n\u003cli\u003eKoutserimpas C, et al. Rare benign soft tissue tumors of the foot: a diagnostic challenge. J Orthop Case Rep. 2020;10(2):18\u0026ndash;22.\u003c/li\u003e\n\u003cli\u003eAoki J, et al. MR imaging of cartilaginous tumors with pathologic correlation. Radiographics. 2004;24(5):1437\u0026ndash;1452.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7171673/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7171673/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eEnchondroma is a rare, slow-growing benign tumor that arises from the remnants of growth plate cartilage and can occur in soft tissue. One of the rare sites where enchondroma is seen is on the plantar surface of the foot. Our patient is a 75-year-old woman with diabetes and controlled blood pressure who has been suffering from the lesion for 2 years with pain and discomfort. Incisional surgery was performed on the medial plantar surface of the foot and the mass was successfully removed. The appearance of the mass and pathological tests confirmed the mass to be an enchondroma. The patient's symptoms improved over time and now she reports normal sensation and movement of the foot without any problems.\u003c/p\u003e","manuscriptTitle":"Massive medial plantar Enchondroma Presenting with Toe Numbness: A Rare Case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-04 00:12:37","doi":"10.21203/rs.3.rs-7171673/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7150dbcd-85eb-4426-bc59-9b6137c66ecd","owner":[],"postedDate":"September 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-22T10:23:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-04 00:12:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7171673","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7171673","identity":"rs-7171673","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}