Nhat Dang Huy Nguyen, Huy Anh Pham, Phi Duong Nguyen
Turkish Journal of Plastic Surgery - 2026;34(2):79-82
Ankle equinus deformity secondary to intramuscular hemangioma (IMH) of the gastrocnemius is an exceptionally rare and often misdiagnosed condition due to its deep anatomical location and nonspecific symptoms. Delayed diagnosis can lead to chronic pain, progressive muscle atrophy, and fixed contracture, resulting in severe gait impairment. We report the case of a 26-year-old woman with a 10-year history of persistent right calf pain, progressive atrophy, and gait dysfunction, culminating in a rigid 35 derece ankle equinus deformity. Magnetic resonance imaging (MRI) revealed an 8 cm x 3 cm intramuscular mass within the medial head of the gastrocnemius, consistent with cavernous hemangioma. The patient underwent wide excision of the tumor via a posterior S-shaped approach, combined with percutaneous Achilles tendon lengthening performed through three small stab incisions to address the mechanical contracture. Histopathological analysis confirmed a cavernous hemangioma. Postoperative rehabilitation was structured over 12 months, leading to full, pain-free ankle dorsiflexion, a normal heel-to-toe gait, and no recurrence on follow-up ultrasound or MRI. This case emphasizes the importance of early imaging, particularly MRI, in identifying deep soft-tissue lesions in patients with unexplained calf pain and contracture. It also highlights the effectiveness of a combined surgical approach - addressing both the lesion and the secondary deformity - in achieving durable pain relief and functional recovery. Further studies with larger patient cohorts and longer follow-up are necessary to validate this treatment strategy.
