Macrodystrophia Lipomatosa of the Foot: A Rare Case of Progressive Macrodactyly in an Adult Male

Abstract

  Introduction: Macrodystrophia lipomatosa is a rare non-hereditary overgrowth disorder where mesenchymal tissues proliferate, mostly in areas innervated by a certain nerve, mostly located in the digits of the hands/feet. This causes cosmetic and functional impairment. Adult case presentation is rare. Presentation of Case: A 36-year-old male exhibit second, third, and fourth digit overgrowth of the left foot associated with pain, and other symptoms including gait problems and problems with foot wear. He had more than one debulking surgery in childhood and adulthood, however, overgrowth had recurred. CT and MRI showed osseous and interface plantar soft tissue hypertrophy with fibrofatty proliferation. He underwent debulking surgery and also left the second, third, and fourth toes. Discussion: Histopathology analysis showed enlargement of adipose tissue with encasing the nerve border, and the diagnosis of macrodystrophia lipomatosa was confirmed. This case advocates the detailed analysis of clinical, imaging and histopathologic data, be it from the same of different times, as it helps differentiate the condition from other causes of local gigantism. The recurrent nature of the condition and frequent surgeries pose a real healthcare challenge. Conclusion: The report reinforces and reiterates the rare adult recurrent nature of macrodystrophia lipomatosa. It also reinforces the value of imaging, histopathology and customised surgical interventions in combination, as they improve the quality of life and functional outcomes.