Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided X-ray, ultrasound, CT, and MRI images, the following major features can be observed:

• Location: The lesion is located in the right plantar (sole) soft tissue, involving the plantar fascia (or its surrounding area) and appearing as a focal or multifocal thickening.
• Shape and Size: On ultrasound and CT images, a relatively regular shaped soft tissue mass with clear boundaries can be seen, measuring approximately 11 cm × 15 cm. The lesion extends relatively deeply but maintains a clear demarcation from the skin and skeletal planes.
• X-ray Findings: The plain radiograph mainly shows thickened plantar soft tissue, with essentially normal osseous structures and no obvious bone destruction or fracture signs.
• Ultrasound Findings: The lesion appears as low or heterogeneously low echogenic areas with relatively clear margins; partial sound attenuation is observed, suggesting a predominant fibrous component.
• CT Findings: The soft tissue mass exhibits relatively homogeneous density, with adjacent fascial thickening and mild enhancement. No evidence of bony erosion is seen.
• MRI Findings: On T1-weighted images, the lesion predominantly exhibits intermediate or slightly low signal intensity; on T2-weighted images, the signal is heterogeneous, with areas of low to intermediate signal, indicating a mix of fibrous and cellular components. Some early or more active regions may present slightly higher signal intensity, suggesting high cellularity or abundant blood supply.

In combination with previous imaging and clinical history, this lesion was resected but has recurred multiple times, indicating a tendency for frequent recurrence.

II. Potential Diagnoses

Based on the patient’s history and imaging appearances, the following are possible diagnoses:

1. Plantar Fibromatosis (Ledderhose Disease):
   This is a fibrous proliferative disorder affecting the plantar fascia, commonly presenting as unilateral or bilateral nodules in the plantar fascia. It grows slowly, can invade surrounding soft tissue, and is prone to recurrence. On imaging, it is characterized by focal soft tissue thickening, and on T2-weighted MRI, it may show low or slightly high signal intensity areas.
2. Scar Proliferation or Scar Tissue:
   Given the patient’s history of previous surgeries, incomplete resection or repeated irritation could lead to proliferative scarring. However, scars typically show lower signal intensity and relatively less active enhancement, and on ultrasound often appear as strong echogenic bands or low echogenic areas.
3. Other Soft Tissue Tumors (e.g., Liposarcoma, Fibrosarcoma, etc.):
   Although less common, in the setting of multiple surgeries and local recurrence, the possibility of a malignant tumor must be considered. However, the imaging does not present obvious malignant features (such as bone destruction, extensive invasion of surrounding structures, or marked enhancement), making this less likely.

III. Final Diagnosis

Taking into account the patient’s age (25 years), the location of the lesion (plantar soft tissue), the history of multiple local surgeries, and MRI findings of a fibrous proliferative lesion, the most likely diagnosis is Plantar Fibromatosis (Ledderhose Disease). Final confirmation can be achieved via histopathological examination (either biopsy or postoperative pathology).

IV. Treatment and Rehabilitation Plan

Considering the high recurrence rate of Ledderhose disease, the treatment should be tailored to the patient’s functional needs, symptom severity, and lesion extent when choosing the appropriate management strategy.

1. Treatment Strategies

• Conservative Treatment: For smaller lesions with mild symptoms or slow progression, methods such as orthotics (shoe inserts), physical therapy, and other devices can help reduce plantar fascial tension and pain, thereby slowing the disease progression.
• Surgical Treatment: In cases of pronounced pain or gait disturbance, or when the lesion is large and has recurred multiple times, surgical excision may be considered. A complete resection with an appropriate margin is crucial to reduce the risk of recurrence. Patients should be advised that recurrence is still possible post-surgery.
• Radiation or Other Adjunctive Therapies: In patients with postoperative recurrence or active lesions, some centers may use low-dose radiotherapy, enzymatic injections, or extracorporeal shockwave therapy, depending on individual patient conditions and specialist recommendations.

2. Rehabilitation/Exercise Prescription

The goal of rehabilitation is to restore foot function, improve gait, and prevent further stimulation or aggravation of the lesion, while ensuring wound healing and safety. The following FITT-VP principles may be applied:

• Type: Focus on low-intensity weight-bearing exercises, plantar fascia stretching, joint mobilization, and strengthening exercises for plantar muscles. Low-impact aerobic exercises such as swimming or cycling may also be included as appropriate.
• Frequency: Initiate with 3-4 sessions per week under the guidance of a physical therapist. If tolerated, progressively increase to 5 sessions per week.
• Intensity: Begin with low intensity to avoid severe pain. Intensity can gradually increase as rehabilitation progresses and the foot’s weight-bearing capacity improves.
• Time: Each session can start with 10-15 minutes and then gradually increase to 30 minutes or more, avoiding excessive fatigue or overstretching of the plantar fascia.
• Variation and Progression: Once the patient adapts to initial exercises, focus on targeted strengthening of the plantar muscles, such as toe-grip exercises or tiptoe exercises. Gradually extend exercise duration and increase load according to tolerance.

Note: If significant pain, an increase in nodule size, or any new symptoms arise during exercise or daily walking, the patient should seek medical advice promptly to re-evaluate and modify the exercise program.

Disclaimer

This report is provided for reference only and does not substitute an in-person clinical diagnosis or professional medical advice. Patients should pursue further evaluation or treatment under the guidance of a specialist and adjust rehabilitation and exercise programs according to individual conditions.