Differential Diagnosis

• Single most likely diagnosis
  • Neuroma (e.g., Morton's neuroma): Given the description of bilateral masses in the feet, a family history, and previous benign biopsy results, neuromas are a strong consideration. They can cause difficulty walking due to their location and size but are typically painless unless compressed.
• Other Likely diagnoses
  • Plantar fibromas: These are benign growths on the soles of the feet that can cause discomfort or difficulty walking. They can be firm and non-tender, fitting the patient's symptoms.
  • Lipomas: Although less common in the feet, lipomas are benign tumors made of fat tissue and can be found almost anywhere in the body. They are usually firm, non-tender, and can cause discomfort depending on their location.
• Do Not Miss
  • Soft tissue sarcomas (e.g., liposarcoma, fibrosarcoma): Although the patient had a previous biopsy showing benign results, the possibility of a malignant transformation or a missed diagnosis of a soft tissue sarcoma cannot be entirely ruled out without considering the patient's symptoms and potentially reviewing the biopsy results.
  • Neurofibromatosis: This genetic disorder can lead to the development of multiple neuromas and other types of tumors. It's crucial to consider this diagnosis given the family history and the presence of bilateral masses.
• Rare diagnoses
  • Pachydermodactyly: A rare condition characterized by thickening of the skin on the fingers or toes, which could potentially cause masses or thickening on the feet, although it's less likely given the description.
  • Elephantiasis: Caused by filariasis, this condition leads to severe swelling and thickening of the skin, typically in the legs and feet. However, it's unlikely in this scenario due to the description of firm, non-tender masses and the lack of mention of significant swelling or parasitic infection history.