The surgery would involve removing the lump until normal bone is reached. The procedure can generally be done on an outpatient basis (as a matter of fact, the risk of complications such as infection may become higher with in-hospital). The difficulty expressed by your doctor is relative. What determines the difficulty is based on the relative complexity of foot anatomy, as compared to (for example) forearm anatomy. The 2nd metatarsal contributes to weight bearing, its best you discuss the actual location of the lump and the chances that there may be issues with the pressure points on which your weight is placed when you are standing. Some metatarsal surgeries involve placing pins in order to make sure alignment is assured during the period of healing (immobilization), you’ll have to keep the pins/wound clean and dry to avoid infections in case the procedure calls for this. If wound care after the procedure wasn’t discussed, then the surgical plan may not call for this, and you’ll be going home with a closed foot.
Its best you discuss the details with your doctor, as these cases are approached with an individualized frame of mind.
Hi Horsie Luver,
Osteochondroma diagnosis is most likely but a biopsy and scan results are definitive study for its diagnosis.
Was a biopsy being done? What type of imaging is being done?
Osteochondroma is the most common benign tumor of bone. It is usually solitary; with lesion not present any where else. It is most common in males and on examination it is easily palpable.
It grows with the individual meaning as you grow, you would have skeletal maturity too and so would the tumor grow.
These would have been some of the reason that they would have come to a conclusion about its diagnosis.
As you have mentioned the lesion is growing in your 2nd metatarsal, which makes it less likely to transform in to a malignant one.
Malignant transformation is more likely in proximal osteochondroma than a distal one.
What did they report on imaging? Did they say that there is a mushroom like appearance on x-ray or there is a bony stalk with a cartilaginous cap?
Above findings on x-ray is hall mark of Osteochondroma.
Why is the surgery planned? Are you having any disability due to this lesion?
Surgical removal is planned or recommended only for symptomatic osteochondroma and for those that arise along the pelvic or shoulder girdle.
Where you been referred to a musculo-skeletal oncologist?
Referral should be made to a musculoskeletal oncologist for proper staging, biopsy, and treatment as appropriate.
The treatment as surgery is only planned for symptomatic lesions as resection.
Care must be taken by the surgeon to ensure that none of the cartilage cap or perichondrium is left, otherwise recurrence can occur. While operating, once the tumor is exposed, dissection is limited to the base of the lesion.
Once the structure is removed and you have a pathologist confirming the diagnosis, the wound would be irrigated well and a surgical drain would be placed. Post-operatively, most resections allow the patient to return to activity as tolerated.
The local recurrence rate after resection of osteochondroma is about 1.8%.
The surgery protocols differ from patient to patient, hospital to hospital and from surgeon to surgeon.
What is the size of lesion mentioned?
Are they planning for an endoscopic resection where in you would be discharged same day?
Keep me informed about your surgery.
Hope this helps.
Wow! First of all, I have to say thank you. I've posted my worries on a few different boards; you two are the only people who replied. I appreciate that!
Okay, now Caliber2005, I'm going to try to answer all your questions ! :)
I've had several xrays, a CT scan, a MRI with gad, 2 different bone scans with two different chemicals. Always inconclusive. I ended up with different opinions from the different scans, but they did rule out infection (there was a worry of osteomyelitsis for a bit). I've never had a true diagonsis of Osteochondroma; I recieved my papers from the hospital and thats what they said. My xray (as far as I can remember, they were done in Feb and June) never described a mushroom like appearance.
The doctor we saw wondered if it might be due to a missed LisFranc fracture dislocation....I don't even remember if we ruled that out.
I'm having the surgery due to pain...I can't walk long distances, I can't place all my weight onto that one foot, my toes lock up, and god, if something hits it? Excruicating. As well, I can no longer fit my foot into a shoe. I have a pair that I use that are stretched out.
I was not referred to a musculo - skeletal oncologist. I do not even think we have one in town.
As for after surgery, I was told bed rest for 4 days, crutches for 2 weeks, and then taking it easy for 2 months. I have a high risk of fracture after the surgery?
The lump presented itself last January. It's on the top of my foot, roughly, extends from the ankle joint and is on 3/4 of the foot. I'm not sure about the endoscopic resection...I just know I'm not spending the night in the hospital.
Okay, I think I've answered all your questions. Let me know if you have any more, but hope this helps.
Have a great holiday!
You told in your last post that it is Osteochondroma.
Here you are saying that you have never been truly diagnosed as having Osteochondroma.
What you mean by saying that you are not been truly diagnosed of Osteochondroma?
As I told you that surgery would be planned only if you have some disabilities due to the lesion.
I think you have understood the surgery well and you also know the line of management of what doctor is going to plan peri-operatively.
What prognosis the doctor has given you?
What have they told you regarding the lesion, whether post-operatively the lesion will regrow or this is the final excision?
Hope you enjoy your Christmas and New Year.
When is the surgery planned?
My surgery is Jan. 9th.
My doctor never said Osteochondroma to me. He said that it's a bone spur like item and that he'll remove it because it is causing me pain. They never mentioned that the lesion could regrow. I've never been truly diagonsed with an Osteochondroma by my surgeon; he said it was a bone spur type thing. When I recieved my admission papers from the hospital it said that it was for an excision of an Osteochondroma, so I'm assuming that's what his end diagonisis is, even if I wasn't involved in it? That's why I turned to the internet; I'd recieved my post op info but I had no idea what the surgery itself was about, pain wise, time wise...so again, thank you for your help!
I am sorry to say but it is not clear to your doctors about your diagnosis.
It’s alright as far as they are doing it to alleviate your symptoms.
I would like you to ask them to send the bony spur for biopsy.
I hope your surgery goes on well.
Keep me informed about surgery and post-op recovery.
I hope this post does not add more confusion.
While the diagnostic gold standard indeed for an osteochondroma involves a biopsy, I think we'll have to be practical to a certain extent.
Consider that bone spurs are much more common than cancers, using American Cancer Society 2007 data and a review on ankle spurs only (Rofo. 1995 Jun;162(6):502-5), we'll have to recommend a biopsy on 20000 people with bone spurs in order to detect one cancer patient. As a reference, for breast cancer, some 4000 women are screened with a mammogram to detect one cancer. Making a recommendation to biopsy all spurs will likely fail to improve outcomes in general.
I don't think that your doctors are amiss in their plans. If there are features of the spur that would raise the suspicion of malignancy - then they would have probably requested it.
The diagnosis written on your papers likely represents a working diagnosis. A final diagnosis will depend on the laboratory findings once the spur is sent to pathology. This is standard practice - I don't think you'll need to request them to send the specimen.
Good luck and happy holidays.
I feel once we know the biopsy report, the management would change. I would still want to have a biopsy on excised part and confirm the diagnosis.
Today was the 13th day after the surgery. I saw my surgeon, had the surgical tape removed and the bandages off. The surgery apparently went well, it was defintely an osteochondroma. Now, when I saw the Doc today, he just sorta glanced at my foot, said it had healed nicely and I could get back to life. (he's a really busy guy...theres about 100,000 people in my town and only a handful of bone doctors) However, when I got home, the first thing I did was rinse off the foot and clean it because it was all gross from the betadine/iodine, whatever was used. When I was cleaning the foot, I noticed that my lump was still there. The lump that I had had surgery for to remove....was still present. I felt it...pressed on, which hurt like hell, but it was rock hard. It felt just like my foot did before surgery! I mean, obviously theres swelling, but what would've caused this?! There is still a large lump on my foot. It is swollen yes, but this is hard!
Of course, once I noticed the lump, I ran and got my shoe (I had a cast boot that I had to use with the bandage...I wore that home from the doctor) and it was just like before. I couldn't fit my foot in. Some, of course, is due to swelling. But what the hell is this rock hard bone thing? I thought I'd gotten rid of this!
I hope someone can reply to this soon, I'm quite terrified and very upset. And very unsure what to do.
Desperately searching for some advice, HorsieLuver
Oh, if this helps....I've also had serious pain in my ankle over the past couple of days...my tendons, ligaments, nerves, whatever, but the pain runs linear on the tops and sides of my foot from my ankle.
Please give me some advice, much appreciated.
How are you feeling?
I am surprised to hear from you that the swelling which you always used to talk about, for which you have got surgery done for removal is still there. It is unbelievable.
Is it another bone spur which was noticed earlier before excision of other swellings?
Is it regrowth of bone spur or osteochondroma again?
Is it that the doctors have not excised it completely and wants to plan other line of management?
I think you should get back to surgeon as early as possible, to check regarding the swelling.
I would like to know if your hospital record says anything about the operative notes.
If yes, what are the operative notes being down?
Only in cases where in patients with the multiple hereditary exostoses form of the disorder, new lesions may form in multiple areas, and they may grow.
Keep me informed if you have any further doubts.
So I saw the doctor today, and he told me it was most likely a hematoma with scar tissue covering it, and that if I still wasn't happy, to come back in four months. I'm not sure that I'm okay with this diagonosis. I know hematomas can feel hard, but this lump on my foot, it feels like bone. Can a hematoma really feel that hard?