Intraneural ganglion of the intermediate dorsal cutaneous nerve of the foot: a Pollyannaish diagnostic challenge

Abstract

Intraneural ganglion cysts are rare, benign mucinous lesions that develop within the epineurium or perineurium of peripheral nerves, most commonly in proximity to synovial joints. Their occurrence in the intermediate dorsal cutaneous nerve of the foot is exceptionally uncommon. Owing to their rarity and nonspecific clinical presentation, these lesions are frequently misdiagnosed, resulting in delays in appropriate management. This report presents a case of an intraneural ganglion cyst arising from the intermediate dorsal cutaneous nerve on the dorsum of the foot. The purpose of this study is to highlight the diagnostic challenges associated with this unusual entity and to emphasize the importance of considering nerve-related pathologies in patients presenting with persistent dorsal foot masses. Initially, the lesion was presumed to be a benign and innocuous condition-a “Pollyannaish diagnosis” - which contributed to delayed recognition of the underlying neural origin. A comprehensive diagnostic approach, including detailed clinical evaluation and imaging studies, was employed to establish the diagnosis. Surgical exploration and excision were subsequently performed with careful preservation of the involved nerve and assessment of potential joint connections. This case underscores the importance of maintaining a high index of suspicion for intraneural ganglion cysts in atypical locations, utilizing appropriate imaging modalities for accurate diagnosis, and undertaking meticulous surgical management. Early recognition and treatment can improve outcomes and reduce the risk of recurrence or neurological complications.