Macrodystrophia lipomatosa (MDL) is an uncommon,
non-hereditary congenital overgrowth disorder that can present manageable yet
vexing challenges when it manifests in the adult foot. Building on our
previously published case, this chapter provides an expanded, practice-oriented
overview of pre-operative work-up, definitive resection of the involved ray,
soft-tissue balancing, and post-operative rehabilitation. Recent literature
confirms that complete ray excision with meticulous soft-tissue debulking
remains superior to serial debulking alone, offering durable cosmesis and
function while reducing recurrence rates to below 20% in carefully selected
adults. Emerging concepts—including nerve-territory mapping, adjunct alpelisib
therapy for progressive forms, and algorithmic multi-technique protocols in
younger patients were integrated that can inform adult care. Novel
reconstructive methods, such as targeted digital-nerve resection with allograft
sensory reconstruction and modified Tsuge-type composite flap transfers, are
critically appraised. Post-operative outcomes at 6- and 18-month review
demonstrate pain-free ambulation in standard footwear, preserved plantar
stability, and high patient-reported aesthetic satisfaction. Future directions
encompass molecular diagnostics (PIK3CA mosaicism) and image-guided 3-D
planning to further personalise surgery. By synthesising current evidence with
detailed operative pearls, this chapter equips foot-and-ankle surgeons with a
step-wise, outcome-focused roadmap for treating adult foot MDL.
Author(s) Details
Reema Alhussein
College of Medicine, Dar Al Uloom University, Saudi Arabia.
Mohammed Alshouli
Orthopedics Surgery Department, Foot and Ankle Surgery, Prince Mohammed Bin
Abdulaziz Hospital, Saudi Arabia.
Please see the book here:- https://doi.org/10.9734/bpi/msraa/v9/5981
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