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Acquired Digital Fibrokeratoma of the Toe
A Rare Anatomical Location
Acquired digital fibrokeratoma is a rare and benign fibrous tumor; it is usually asymptomatic, and frequently arises from the fingers. The diagnosis is easily confirmed by pathologic evaluation. However, in some cases, it may be misdiagnosed as other benign conditions, mainly adnexal tumors and common warts, especially when located on the foot and toes. In this article, we report the case of a 45-year-old man who presented to our clinic for an acquired growth over the plantar surface of the second right toe. The tumor had evolved for 1 year and affected the patient's activities and mobility. On examination, the lesion was a dome-shaped, firm tumor with keratotic distal changes and a broad base attached to the overlying skin. Pathologic assessment was consistent with the diagnosis of acquired digital fibrokeratoma, ruling out other causes of abnormal growth. The tumor was completely excised with surgery, with excellent outcomes and no recurrence at follow-up. Although acquired digital fibrokeratoma is a rare condition, mostly located on the distal upper extremities and fingers, it should be considered in the differential diagnosis of plantar soft-tissue tumors. Surgical management remains the mainstay of treatment.
Ablative fractional laser is suggested to promote wound healing in diabetic and venous leg ulcers. In this article, we report the treatment outcome of a recalcitrant foot ulceration related to lower leg arteriopathy. A 43-year-old man with typical digital substraction angiographic findings of arteriopathy was admitted to our department after 30 sessions of hyperbaric oxygen therapy. There was heterotopic tissue within the ulcer consistent with osseous metaplasia and mature bone tissue. This tissue was removed with full-field erbium:yttrium-aluminum-garnet laser, and the remaining parts received fractional erbium:yttrium-aluminum-garnet laser for the induction of wound healing. A decrease in ulcer dimensions was achieved by the second month of laser interventions without recurrence in the first-year control.
The Bipartite Medial Cuneiform
A Case Report
This report discusses an unusual case of a 23-year-old woman with a painful bipartite medial cuneiform and severe arthritic and cystic changes at the partition with no history of trauma. Magnetic resonance imaging confirmed a large cyst with subchondral erosions at the dorsal and plantar segments with significant bone marrow edema. Definitive treatment consisted of arthrodesis on the dorsal to plantar segments using one lag screw, demineralized bone matrix grafting, and a bone stimulator.
Eumycetoma, caused by fungi, is a neglected tropical disease. It is endemic in the “mycetoma belt” countries but rare in North America. We report a case of pedal eumycetoma in the state of Maryland. A 51-year-old male immigrant from Guatemala presented with multiple, enlarging nodules on the dorsal surface of his left great toe present for 1 year, and a new one in the left arch area present for 6 months. The nodular lesions were surgically excised in two separate operations. Pathologic evaluation of all nodules revealed eumycetomas characterized by the Splendore-Hoeppli phenomenon, showing an amorphous eosinophilic center filled with numerous fungal hyphae, observed on periodic acid-Schiff–stained slides, with a surrounding cuff of neutrophils. Polymerase chain reaction–based sequencing identified Cladosporium cladosporioides in the tissues. The patient was further treated with oral fluconazole for 2 months. The patient recovered well postoperatively and had no recurrence at 20-month follow-up. In conclusion, even though eumycetoma is regarded as a rare disease in North America, its incidence may be higher than reported because of millions of immigrants from endemic regions in the United States, which highlights the need to raise awareness of this devastating disease in the medical community. Eumycetoma needs to be differentiated from other infectious and noninfectious benign and malignant lesions. Optimal treatment includes surgical excision with antifungal therapy.
Surgical management of hallux rigidus using a polyvinyl alcohol synthetic cartilage implant has gained popularity among foot and ankle surgeons. Although uncommon, appropriate diagnosis and management of a periprosthetic implant infection is critical in limiting morbidity. We present a case report and staged technique for converting a first metatarsal synthetic cartilage hemiarthroplasty to arthrodesis in the setting of a periprosthetic joint infection.
Crossing the barrier of an open physis by primary aneurysmal bone cyst is an exceptional phenomenon. We present a rare case of primary active aneurysmal bone cyst of the distal tibia in a 15-year-old boy in whom the lesion had crossed the open lateral distal tibia physis. The diagnosis was confirmed by radiographs, computed tomography, magnetic resonance imaging, and histopathologic findings. The lesion was successfully treated by extended curettage and allograft impaction. The patient was asymptomatic when last seen at 30 months.
A Rare Case Presentation
Bilateral Gangrene of Feet Secondary to Systemic Lupus Erythematosus and Raynaud Phenomenon in an Adolescent
Systemic lupus erythematosus is an autoimmune disorder that affects several organs and systems in the human body. Digital gangrene is known to be a rare and severe complication of systemic lupus erythematosus that could lead to amputation. We report a case of an adolescent who presented with an autoimmune disorder and multiple comorbidities and developed gangrenous toes.
Subungual Exostosis on the Right Hallux
An Illustrative Case Report
Subungual exostosis (SE) is a benign, relatively uncommon bony growth underneath the nails of the distal phalanx of toes or fingers, with a majority on the toes. Clinically, it has two subvariants—protruded and nonprotruded growths from nail plates—which are treated differently. In this article, we report a case of protruded SE in a teenager with illustrative surgical excision. A 15-year-old boy presented with a painful growth on his right great toe of 6 months' duration. Physical examination revealed a 1-cm-diameter, solid, erythematous, rough, irregular growth penetrating through the skin along the dorsolateral nail bed of the right hallux with deformity of the lateral nail plate. Radiographs showed an elevated mass over the distal phalanx of the right lateral hallux. The mass was surgically excised and histopathologic examination confirmed the diagnosis of SE. The patient had no relapse or recurrence at follow-ups of 6 and 18 months. Subungual exostosis is a relatively uncommon bony growth in the toes. Radiography is favored for the diagnosis. Complete surgical excision is the optimal treatment, with rare recurrence. It needs to be differentiated from other bony lesions, including bizarre parosteal osteochondromatous proliferation, myositis ossificans, fibro-osseous pseudotumor, osteochondroma, and enchondroma.
Giant cell tumors are benign tumors that are locally aggressive and rare in the foot. Giant cell tumors involving bone in the foot have an incidence of 1.2% to 2.8%, whereas giant cell tumors of the tendon sheath constitute 3% to 5% of all giant cell tumors in the foot and ankle. We present a case of giant cell tumor of the soft tissue disguised as a giant cell tumor of bone in a healthy 29-year-old male patient. Through radiographic and magnetic resonance imaging evaluation, it was determined that this patient had a bone tumor invading the distal and proximal phalanges of his left great toe with the involvement of soft tissue. With the use of the evidence-based medicine and patient expectation, the decision was made to amputate the digit. To much surprise, when the histopathologic results were reviewed, it was determined that the excised lesion was consistent with giant cell tumor of soft tissue that did not involve the bone.
