Browse
Hallux valgus interphalangeus deformity has been previously reported in the literature following trauma and first metatarsophalangeal joint fusion. However, to the best of our knowledge, hallux varus interphalangeus deformity has not been previously reported. We present the case of a 26-year-old skeletally mature woman who sustained an acute, open hallux varus interphalangeus injury following an osteochondral fracture of the medial head of the proximal phalanx.
Background
Stenotrophomonas maltophilia is an uncommon gram-negative bacterium often found in individuals with long-standing broad-spectrum antibiotic use or catheter use; individuals undergoing hemodialysis; and individuals with prolonged respiratory disease, specifically, cystic fibrosis. To our knowledge, there are few reported cases of S maltophilia being the causative pathogen of infection in a diabetic foot wound.
Methods
Following multiple surgical procedures and deep tissue cultures, S maltophilia was determined to be a secondary opportunistic colonizer of the wound, necessitating a change in antibiotic therapy.
Results
The cultured pathogen was sensitive to ceftazidime, levofloxacin, and trimethoprim-sulfamethoxazole. The treatment team chose to use ceftazidime, as it also provided antibiotic coverage for the initial wound and blood cultures. Change in antibiotic therapy was initiated following multiple surgical procedures and angioplasty of the lower limb. The patient was discharged with a peripheral intravenous central catheter for outpatient antibiotic therapy.
Conclusions
Prolonged exposure to broad-spectrum antibiotics in individuals with multiple comorbidities including diabetes mellitus provides an advantageous environment for growth of uncommon multidrug-resistant organisms. Stenotrophomonas maltophilia may complicate the treatment of diabetic foot infections as an opportunistic pathogen. Understanding the implication of long-term broad-spectrum antibiotic treatment in the diabetic patient is important in managing postoperative complications and determining the correct course of treatment. The emergence of atypical pathogens in diabetic wounds must be managed appropriately.
This case study presents a 72-year-old male patient who presented with multiple schwannomas. The patient underwent several soft-tissue mass excisions performed by general surgery and podiatry. The physical examination displayed multiple nodules on the left foot, ankle, and previously in the groin. Magnetic resonance imaging displayed high–T2-weighted signal masses in the left plantar heel and ankle. These masses were excised and, through pathologic analysis, were diagnosed as schwannomas. Immunohistochemistry displayed a mosaic pattern of INI1 expression, a gene associated with tumor suppression. The patient demonstrated findings consistent with multiple schwannomas (eg, schwannomatosis or neurofibromatosis type 2). Because of the patient's medical history, neurofibromatosis type 2 was more probable.
Nontraumatic bony abnormalities of the foot occur at different rates, according to the literature. However, it is uncommon to see rare variations presenting together in one patient. This article discusses two less common anomalies: fused os intermetatarseum and polymetatarsia without polydactyly. Etiology, symptomology, diagnosis, and treatment are reviewed, in addition to the relationship of the two conditions to each other. We then discuss a case where both anomalies are present at the same time in a 17-year-old patient.
We report a unique case of the total loss of the intermediate cuneiform by posttraumatic avascular necrosis resulting from a left foot open fracture and dislocation of the navicular bone and medial and intermediate cuneiforms at the Chopart and Lisfranc joints in a 64-year-old woman. The injury was managed with open reduction and internal fixation with Kirschner wires and cannulated screws. During postoperative follow-up, we observed avascular necrosis of the intermediate cuneiform and the total loss of the bone. An extensive English literature search revealed only one case report published on this topic. Thus, we provide this case study to help guide clinical decision making in the future.
A case presentation of an adolescent with tarsal navicular avascular necrosis is presented. External fixation with tarsal navicular diastasis is a simple, straightforward management option to allow osseous regrowth and bone healing. In this case, the external fixator was well tolerated and the patient demonstrated a quick return to function without pain or discomfort. The external fixation technique with tarsal navicular diastasis is an uncommon but effective means of reversing the tarsal navicular avascular process and avoiding an open technique such as arthrodesis.
The giant cell tumor of tendon sheath (GCTTS) is a benign lesion most commonly attached to the tendons and bones of the fingers, hands, and wrists. The involvement of GCTTS to the foot is uncommon. The GCTTS invading tarsal bones and intertarsal joints is not described yet, and the appropriate diagnosis and treatment remain unclear. We report a case of GCTTS with the involvement of tarsal bones and intertarsal joint. Computed tomography scan and magnetic resonance imaging were used to further diagnose and evaluate the quality and range of tumor. The patient was treated with surgical excision of the tumor without application of bone graft. After adequate clearance of the tumor, the patient returned to an asymptomatic walk in 3 months. No malfunction, fracture, or tumor recurrence was found in 2-years follow-up. This report includes clinical, radiologic, histologic diagnostic, and surgical challenges in an unexpected lesion and a review of the literature.
Distal to its origination from the sciatic nerve, the common fibular (peroneal) nerve divides into the superficial and deep fibular (peroneal) nerves. Whereas the deep fibular nerve continues its course into the anterior compartment, the superficial fibular nerve (SFN) usually arises near the fibular neck and projects distally within the lateral crural compartment before entering the superficial fascia proximal to the ankle. In this report, we describe a unilateral case where the SFN arises within the anterior crural compartment and remains there for the remainder of its course deep to the deep fascia of the leg. Surgeons should be aware of anomalies such as this, for example, when performing fasciotomies to avoid inadvertently damaging an anomalously placed SFN.
Giant cell tumor of the tendon sheath (GCTTS) in the foot is a rare pathology and is involved in the differential diagnosis of soft-tissue tumors of the foot and ankle. Although it can affect any age group, GCTTS mainly occurs at the 3rd and 5th decade and is more common in females. Histopathologic examination is a major definitive method for diagnosis, although physical examination and radiologic imaging are helpful in reaching a diagnosis preoperatively. Many treatment options exist but marginal excision is the most commonly used treatment. We describe the case of a 26-year-old pregnant woman with a multi-fragmented mass extending from the first web space to the plantar aspect of the metatarsophalangeal joint (MTP) of the left great toe associated with flexor hallucis longus tendon after trauma. She had pain that worsened with activity and wearing shoes. After pregnancy, a marginal excision with dorsal longitudinal incision in the first web space was performed under spinal anesthesia. The lesion was diagnosed as a localized type tenosynovial giant cell tumor. At the last follow-up appointment in the 23rd month, the patient was doing well and there was no recurrence of the lesion. GCSST should be considered in the differential diagnosis of plantar masses of foot. Although, GCTTS is frequently seen in females, it has not been previously reported in a pregnant woman with an extremely rare condition after trauma.
A schwannoma is a slow-growing, neurogenic tumor composed of Schwann cells arising from a peripheral nerve sheath. The authors present a rare finding of a schwannoma of the sural nerve that was overlooked in a 51-year-old female with radiating foot pain. This case highlights the clinical implications and important teaching points in recognizing a schwannoma of the foot.
