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A 13-year-old girl presented to the emergency department in stable condition with a retained penetrating knife wound injury in her right foot. Routine radiographs taken of the foot revealed deep tissue penetration by the knife without frank bony involvement. It was decided to remove the object in the operating room. Simple removal was performed, followed by wound exploration. The patient was admitted to the hospital for one night of observation and then was discharged without further complications.
Retronychia, the posterior embedding of the nail bed into the proximal nail fold, can be a complex clinical dermatologic diagnosis that may mimic other inflammatory ungual diseases or tumors of the nail. It has been related to a history of severe systemic conditions that secondarily affect the nail matrix and is commonly associated with onychomadesis. We present a case of retronychia of the foot with a purely traumatic origin, nonconcomitant with onychomadesis, that was diagnosed by color Doppler ultrasound in a long-time practitioner of martial arts who was otherwise healthy. Color Doppler ultrasound is an excellent imaging technique for supporting the diagnosis of retronychia. It provides information on the exact location and morphology of the nail plate as well as the presence of inflammatory signs in the ungual and proximal periungual regions. Additionally, this imaging technique can support the differential diagnosis with other nail conditions. Since there are many sports or activities that can potentially injure the toenails, retronychia may be an underestimated entity and the present case can raise the awareness of this condition and show the usefulness of color Doppler ultrasound.
Hereditary hemorrhagic telangiectasia (HHT), which is also known as Osler-Weber-Rendu syndrome, is a group of related disorders characterized by the development of arteriovenous malformations. These malformations occur in almost all organs but predominantly in the skin, intestines, liver, lungs, and brain. This is a case report of a patient with cutaneous manifestations of HHT in the lower extremities as diagnosed by his podiatric physician. To our knowledge, the literature does not present any case reports in which cutaneous manifestations of the lower extremities followed by a further work-up allowed a diagnosis of HHT.
Cutaneous horns (cornu cutaneum) are chronic, dense, hyperkeratotic cutaneous lesions resembling the horn of an animal. These lesions are associated with a variety of benign, premalignant, and malignant cutaneous diseases. Cutaneous horns are often found on the upper parts of the body, such as the face, neck, and shoulders. These lesions rarely occur in areas with no sun exposure, such as the feet. We present the case of a 51-year-old man with two cutaneous horns on the lateral aspect of the third digit of the left foot. Treatment consisted of excision of the lesions and application of a full-thickness skin graft from the ipsilateral sinus tarsi.
Symptomatic Os Vesalianum
A Case Report and Review of the Literature
Os vesalianum is a rare accessory bone located proximal to the base of the fifth metatarsal in the peroneus brevis tendon. It is a radiographic diagnosis and mostly an asymptomatic incidental finding with a reported prevalence of 0.1% to 0.9%. Only 11 symptomatic cases have been described in the literature. Surgical therapy has been reported with good outcome in adults, whereas recurrence may follow excision during skeletal growth. We report a case of a 19-year-old girl with chronic weightbearing pain proximal to the base of the fifth metatarsal of her left foot. She first experienced exacerbated pain on increased loading when she started professional training as a shop assistant. Because several months of nonsurgical therapy failed, the decision was made to surgically excise the accessory bone from the peroneus brevis tendon via a longitudinal incision and a simple tendon-to-tendon reconstruction. Postoperative treatment consisted of using a walker to avoid weightbearing for 6 weeks, followed by a gradual return to full weightbearing as tolerated. At final follow-up, the patient was fully asymptomatic and was able to return to work. Citing this case, this article discusses differential diagnoses and treatment options for os vesalianum.
We report an unusual case of adenocarcinoma of the lung metastasizing to the proximal phalanx of the third digit in a 56-year-old woman with overlying complex regional pain syndrome. The patient was initially treated for neuroma, fracture, and neuropathic pain with no improvement over a 4-month period before presenting to the emergency department for left third digit pain. Radiographic imaging showed substantial osteopenia and mottling; magnetic resonance imaging demonstrated an aggressive lesion to the proximal phalanx. The patient underwent excision of the lesion, revealing metastatic moderately differentiated adenocarcinoma.
Cerebrotendinous xanthomatosis is a rare, autosomal recessive, lipid storage disease with accumulation of cholestanol in most tissues, particularly in the Achilles tendons. We described a 23-year-old female patient who had progressive painfull swelling of both Achilles tendons due to cerebrotendinous xanthomatosis. We performed surgery on both-side Achilles tendon tumors. Wide degenerative areas of the tendons were resected, and the flexor hallucis longus tendon was harvested and transferred to reconstruct motion function.
An intramuscular lipoma is a deep-seated, rare, benign mesenchymal tumor that arises in skeletal muscle. These soft-tissue masses are rarely reported in the foot. We describe an unusual case of an intramuscular lipoma of the flexor hallucis brevis muscle. A review of the literature revealed only one previous report of this lesion in the foot.
Metastatic Melanoma of a Metatarsal
A Case Report
A 53-year-old woman presented with painful swelling of the right forefoot presenting clinically as a metatarsal stress fracture. Radiographs showed destructive changes, and diagnostic imaging revealed an aggressive neoplasm. The lesion was biopsied, and the pathologic diagnosis was metastatic melanoma. A thorough physical examination and advanced imaging did not reveal a primary tumor. Ray resection was performed with en bloc resection of the neoplasm. The patient continues to receive long-term immune stimulation chemotherapy 34 months after the ray resection.
We report on the rare case of multiple open interphalangeal dislocations. This uncommon pathologic condition results from dorsiflexion and axial loading of the digit. In the present patient, closed reduction was not possible. We review the literature on this pathologic condition and present a case of open irreducible dislocation of the lesser interphalangeal joints complicated by peripheral neuropathy and treated with resectional arthroplasty.
