Tarsal coalitions represent a cohort of conditions characterized by bony, cartilaginous, or fibrous union of two or more tarsal bones. These disorders are often poorly understood by medical professionals, often leading to delays in diagnosis and treatment. They may be asymptomatic or cause hindfoot pain, stiffness, decreased range of motion, and foot deformities. Coalitions can be investigated by an ascending sequence of imaging including radiography, computed tomography, and magnetic resonance imaging. They may be managed conservatively with orthoses, activity modification, physiotherapy, anti-inflammatory medications, or definitive surgical intervention. To our knowledge, cuboid-lateral cuneiform coalition has not been reported in the orthopedic literature. We describe a 40-year-old woman with this condition who reported a 1-year history of left foot pain and stiffness. She was definitively diagnosed with magnetic resonance imaging and was managed conservatively with an aircast boot and hydrocortisone injection.
Eccrine poroma is a rare benign adnexal neoplasm originating from a portion of the intraepidermal eccrine sweat gland duct and the acrosyringium. Typically, the lesions are asymptomatic, slow-growing nodules, which may be found in any sweat gland–bearing area. Multiple red lacunae, glomerular vessels, hairpin vessels, flower- and leaf-like vascular patterns, a polymorphic vascular pattern, globule/lacunae–like structures, a frog egg–like appearance, and comedo-like openings have been defined as characteristic dermoscopic patterns of the disease. We report a case of eccrine poroma in an unusual periungual and subungual location mimicking ingrown toenails. The dermoscopic findings of the lesions were compatible with those of eccrine poromas located in areas other than the periungual area. Recurrence was observed after the first excisional biopsy. There was no recurrence 10 months after the second surgical intervention, and near-complete regrowth of the nail plate was achieved. Eccrine poroma should be considered as a differential diagnosis in the presence of slow-growing, erythematous, painful, hemorrhagic papular lesions located in the periungual area in conjunction with a prediagnosis of ingrown toenails and malignant processes.
Sesamoid bones and accessory ossicles are common incidental findings on radiographs. These can occasionally become symptomatic, usually after a precipitating event such as an injury or overuse, or they can be incidental findings unrelated to the presenting pathology. The aim of this study was to highlight a rare case of a bipartite fifth metatarsal sesamoid bone and to review previous literature regarding sesamoid bones and accessory ossicles.
Osteolysis, caused by active resorption of bone matrix by osteoclasts, can be primary or can develop secondary to a variety of disease processes. An elevated level of inflammatory cytokines in the local milieu and increased blood flow secondary to infection or autonomic neuropathy stimulate the osteoclasts and cause bone loss in the diabetic foot. Charcot's neuroarthropathy and osteomyelitis are well-known foot complications of diabetes, and secondary osteolysis has largely been underappreciated and, hence, underreported. Plain radiographs, an initial component in the evaluation of the diabetic foot, may not successfully differentiate secondary osteolysis from osteomyelitis. We describe a patient with phalangeal osteolysis secondary to soft-tissue infection in whom a correct and timely diagnosis helped avoid unnecessary surgical interventions.
This report highlights an unusual case of an atypical melanocytic proliferation in a pediatric patient and the surgical method used to repair the defect. I describe a 10-year-old boy with hallux irregular discoloration that was present from birth and rapidly enlarging. A biopsy led to the diagnosis of atypical melanocytic proliferation, which may represent an unusual manifestation of early melanoma in situ. Complete excision of the patch was performed, and the hallux was repaired using a double advancement flap for closure, thus curing the patient.
Behcet's disease is a rare autoimmune systemic vasculitis. It usually presents with a symptom complex involving primarily mucocutaneous lesions, genital lesions, and uveitis. When it involves the lower extremity, venous and arterial disease predominates, and joint involvement occurs in approximately 50% of patients. We present a patient with Behcet's disease who was initially referred to us for chronic toenail pathology.
Adenoid cystic carcinoma is a rare, slow-growing neoplasm. It is most commonly located in the salivary glands, affects people older than 55 years of age, and has a predilection for women. These lesions may recur locally but have shown low metastatic potential. We present the unique case of a 71-year-old female with a nonraised hyperpigmented lesion isolated to the right heel. Confusion surrounded the clinical presentation of this dermatologic lesion, and many physicians postulated several differential diagnoses. The purpose of this case report is to bring further awareness to this rare dermatologic variant of adenoid cystic carcinoma, which has been rarely reported in the literature.
An isolated medial cuneiform fracture is a rarely encountered injury of the foot. We present a case of an isolated medial cuneiform fracture in a patient after sustaining a fall from a 15-foot height. Treatment consisted of primary arthrodesis of the first tarsometatarsal joint due to a high degree of comminution and intra-articular pain. When radiographs are inconclusive and the index of suspicion remains high for a lesser tarsus fracture, computed tomography is recommended. In patients with minimal displacement, conservative treatment is usually successful in achieving osseous fusion. When the fracture is displaced, intra-articular, or comminuted, surgical intervention, including open reduction with internal fixation and primary arthrodesis, should be considered.
We present a rare case of calcaneal chondroblastoma with subsequent surgical revision after graft rejection in a 13-year-old boy. Complications were encountered after the injectable bone graft filler was placed in the calcaneus after curettage. With noted subsequent sinus tract formation, revision surgery was performed that involved dissection of the sinus tract, removal of bone void filler, and application of demineralized bone matrix sponge human allograft soaked in vancomycin-impregnated saline. Sixteen weeks after the revision surgical intervention, the patient resumed normal athletic activities without pain or restrictions. One and a half years after the initial surgery, the patient had complete resolution of the calcaneal cyst and was discharged.
Closed rupture of the extensor hallucis longus (EHL) tendon is rare, with most cases caused by either direct penetrating trauma or predisposing factors such as corticosteroid injection and iatrogenic trauma incidences. Almost all of the previous case reports have reported on rupture of the EHL tendon rather than the EHL muscle. In this report, we highlight an unusual clinical presentation of a rupture of the EHL muscle and discuss its predisposing factors. This patient was a taekwondo athlete with EHL muscle rupture secondary to repetitive overuse without any underlying systemic or local predisposing factors or direct trauma. Fifteen months after successful surgical treatment, he became fully functional again as an elite taekwondo athlete.