# Intramuscular hemangioma presenting as ankle equinus deformity in a pediatric patient: a case report and literature review

## TL;DR

A 7-year-old girl with a rare muscle tumor in her leg developed a foot deformity, which was successfully treated with injections and surgery.

## Contribution

This case report highlights the rare association of intramuscular hemangioma with ankle equinus deformity and effective treatment strategies.

## Key findings

- MRI confirmed a large intramuscular hemangioma in the gastrocnemius muscle.
- Sclerotherapy combined with Achilles tendon lengthening led to functional recovery and painless walking.
- The patient achieved 20° dorsiflexion and independent ambulation after 2 years.

## Abstract

Ankle equinus deformity is characterized by limited ankle dorsiflexion, causing gait disturbance, pain, and functional limitations. Common causes include congenital anomalies, cerebral palsy, and muscular dystrophy, while intramuscular hemangiomas (IMHs) are extremely rare. The patient, a 7-year-old girl, presented with right ankle equinus and toe-walking, first noted at age 5, as a persistent, non-tender swelling in the posterior leg. Examination showed fixed ankle equinus, asymmetric calf circumference, and a 1 cm leg length discrepancy. Magnetic resonance imaging (MRI) revealed a large IMH involving the gastrocnemius muscle. She underwent five sessions of sclerotherapy over 18 months, followed by open Achilles tendon Z-lengthening. At 2-year follow-up, she had a painless plantigrade foot with 20° dorsiflexion and was independently ambulating, indicating successful functional recovery. This case highlights the rare presentation of ankle equinus due to IMH. MRI is essential for diagnosis, and combined sclerotherapy with tendon lengthening can achieve excellent outcomes.