Technique Tip: Glomus Tumors in the Foot: A New Surgical Technique for Removal

Glomus tumors may present as either diffuse pain in the area of the nailbed or as very localized acute pain experienced when pressure is applied with a pointed object such as a pen over the lesion under the nail.1,5–8 To date, no etiological factors in the development of glomus tumors have been identified. Despite the relative rarity of this entity, one must be aware of the possibility of glomus tumor when a patient presents with persistent pain around his or her nailbed and has experienced previous unsuccessful surgery for pain. The differential diagnoses for this type of nail pain include melanoblastoma, melanoma, neurinoma, chronic paronychia, gout arthritis, and foreign-body granuloma. Patients with glomus tumors commonly experience temperature hypersensitivity and are especially sensitive to cold. The glomus tumor seems to be a controlled arteriovenous anastomosis or shunt between terminal vessels with the function to regulate peripheral blood flow in the digit. It is also referred to as a neurovascular nodule or a neuromyoarterial apparatus. Diagnosis of glomus tumors can in some cases be based on the presence of a small blue dot at the base of the nail. In the absence of this visual cue, radiographic evidence of a perforating lesion of the phalanx may be obtained using plain radiographs or MRI with contrast. The glomus tumor enhances. The glomus tumor can also be visualized occasionally by an MRI without contrast2,4 or by using a bone scan or ultrasound3 (Fig. 1, A and B). Histologically, glomus tumors are surrounded by a connective tissue capsule and contained bundles of myelinated and unmyelinated nerve fibers. In addition,