Painful Angiomyoma of the Heel Region: A Rare Case Report.

Background/aim: Angiomyomas are rare benign smooth muscle tumors originating from the tunica media of blood vessel walls, most frequently affecting the lower extremities in middle-aged women.

Case report: We report the case of a 51-year-old female with a six-month history of a painful, palpable mass in the right heel. Physical examination revealed a soft, mobile, and tender subcutaneous nodule. Ultrasound imaging identified a 0.5 cm well-defined hypoechoic lesion in the subcutaneous layer, without internal blood flow, initially suspected to be an epidermoid cyst or fibrous tumor. Surgical excision of the lesion was performed, and histopathological analysis revealed a well-encapsulated tumor consisting of spindle-shaped cells with eosinophilic cytoplasm and bland nuclei, accompanied by vascular components. Immunohistochemical staining confirmed positive expression of SMA, establishing the diagnosis of angiomyoma. The patient experienced an uneventful postoperative recovery.

Conclusion: This case highlights the diagnostic challenges of angiomyomas, given their nonspecific clinical presentation and imaging findings. While magnetic resonance imaging may reveal characteristic features such as strong gadolinium enhancement, definitive diagnosis relies on histopathological evaluation. Clinicians should include angiomyoma in the differential diagnosis of painful subcutaneous masses in the foot and ankle, particularly in middle-aged women. Surgical excision remains the definitive diagnostic and therapeutic approach, with low recurrence rates reported.