A Case of Macrodystrophia Lipomatosa of the Lower Extremity: An Effective Measuring of the Dynamic Plantar Pressure for Severe Congenital Deformity.

Abstract

Macrodystrophia lipomatosa is a rare, congenital, non-hereditary form of localized gigantism characterized by abnormal fibroadipose tissue proliferation. Here, we report a case of a 39-year-old male with macrodystrophia lipomatosa of the whole left extremity with refractory foot ulcer. Imaging showed fibroadipose tissue proliferation and severe giant deformities of the second and third toes. The plantar pressure measurements during gait revealed that both peak pressure and pressure-time integral around the ulcer were increased; therefore, the forefoot deformities might have caused the ulceration. To decrease and redistribute the plantar pressure, debulking the forefoot soft tissue, involving the second and third toe amputation, and cutting the flexor tendon of the fifth toe of severe flexion contracture were performed. No recurrences were found 6 months after surgery. The plantar pressure measurements helped in planning surgical strategies, and we evaluated the loading condition of the foot sole despite a severe congenital deformity.