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

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.