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Tarsal coalitions typically occur at the talocalcaneal or calcaneonavicular joints. Common findings are pain, limited range of motion, and a pes planus deformity. The focus of this case report includes the presentation, imaging, treatment, and outcomes for a 21-year-old woman diagnosed with a rare lateral cuneocuboid coalition with chronic pain. Clinical and radiographic examinations, typically used to diagnose the common coalition, were unremarkable. Magnetic resonance imaging was diagnostic of the lateral cuneocuboid coalition, which was successfully treated with surgical resection. At 6-year follow-up, she reports resolution of symptoms and has returned to her normal presurgical activity level pain-free. This case is only the third lateral cuneocuboid coalition reported in the literature. The rarity of this coalition and its nonsuspicious clinical presentation make it worthy of acknowledgment.
Behcet's Disease
A Case Report
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.
Isolated Cuboid-Lateral Cuneiform Coalition
A Rare Cause of Foot Pain
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.
A 55-year-old man with poliomyelitis presented with a plantarflexed foot and painful ulceration of the sub–first metatarsophalangeal joint present for many years. A two-stage procedure was performed to bring the foot to 90°, perpendicular to the leg, and resolve the ulceration. The first stage corrected only soft-tissue components. It involved using a hydrosurgery system to debride and prepare the ulcer, a unilobed rotational skin plasty to close the ulcer, and a tendo Achillis lengthening to decrease forefoot pressure. The second stage corrected the osseous deformity with a dorsiflexory wedge osteotomy of the first metatarsal. The ulceration has remained closed since the procedures, with complete resolution of pain.
Compartment syndromes associated with arthroscopy have been rarely reported. Compartment syndrome after knee arthroscopy has been reported in some case reports, whereas we could find only one case report of acute compartment syndrome following ankle arthroscopy after Maisonneuve fracture. However, there has been no previous report of a case of acute compartment syndrome after ankle arthroscopy in an atraumatic patient. In this article, we present a case of acute compartment syndrome during ankle arthroscopic procedures in an atraumatic patient.
Solid-cystic hidradenoma is a benign cutaneous tumor with eccrine sweat gland origins that is most commonly found in the head, neck, trunk, and upper extremity regions of patients in the middle to older age groups. These lesions are generally asymptomatic, slow-growing, solitary, and nonulcerative in presentation. Degenerative malignant transformation of this tumor is very rare. In this case report, the authors describe the marginal surgical excision and subsequent microscopic pathologic diagnosis of a moderate sized solid-cystic hidradenoma of the dorsolateral forefoot in a middle-aged male patient.
Enchondroma is the most common benign cartilage bone tumor of the toes. In contrast, the foot is a rare region for chondrosarcoma, and the involvement of phalanges is extremely rare. In this article, we report an unusual case of intermediate chondrosarcoma involving the proximal phalanx of the great toe of a 52-year-old woman who was previously treated with curettage and bone grafting because of misinterpretation of enchondroma at a local hospital. She presented complaining of pain and swelling that she had experienced for a period of 1 year after the first operation. Radiography revealed a lytic lesion with a subtle punctuate calcification and endosteal scalloping in the proximal phalanx of the great toe. Gadolinium-enhanced magnetic resonance imaging confirmed soft-tissue involvement and cortical destruction. Staging evaluation with computed tomographic scan of the chest, abdomen, and pelvis was performed to ensure that there was no metastatic disease. Subsequently, a bone biopsy was performed, and the diagnosis was grade 2 chondrosarcoma. The patient was informed about the recurrence of the lesion and the clinical context on the basis of tumor biology of chondrosarcoma and was offered the option of either amputation or wide resection. She preferred the latter. The patient was treated with wide resection and underwent reconstruction with cement and Kirschner wire. She remains free of disease after 1 year of follow-up.
Osteoid Osteoma
An Uncommon Cause of Foot Pain
An osteoid osteoma located in the forefoot can be difficult to diagnose, and the diagnosis is frequently delayed. We present a clinical case of a patient with pain, erythema, and swelling of the left forefoot with no history of trauma. Although rarely seen in the metatarsal, osteoid osteoma should be included in the differential diagnosis of foot pain. Findings from radiographs, magnetic resonance images, and a detailed clinical history led to the diagnosis of osteoid osteoma of the left second metatarsal. The lesion was surgically excised using curettage. This process significantly weakened the lateral cortex of the metatarsal shaft. To correct this surgically induced stress riser, an external fixator was applied to provide stability, allow for callus distraction, and allow the patient to walk as early as possible. We review osteoid osteoma, including the classic clinical presentation and treatment associated with this benign bone tumor. (J Am Podiatr Med Assoc 97(5): 405–409, 2007)
Pure open dislocation of the ankle, or dislocation not accompanied by rupture of the tibiofibular syndesmosis ligaments or fractures of the malleoli or of the posterior border of the tibia, is an extremely rare injury. A 62-year-old man injured his right ankle in a motor vehicle accident. Besides posterolateral ankle dislocation, there was a 7-cm transverse skin cut on the medial malleolus, and the distal end of the tibia was exposed. After reduction, we made a 2- to 2.5-cm longitudinal incision on the lateral malleolus; the distal fibular fracture was exposed. Two Kirschner wires were placed intramedullary in a retrograde manner, and the fracture was stabilized. The deltoid ligament and the medial capsule were repaired. The tibiofibular syndesmosis ligaments were intact. At the end of postoperative year 1, right ankle joint range of motion had a limit of approximately 5° in dorsiflexion, 10° in plantarflexion, 5° in inversion, and 0° in eversion. The joint appeared normal on radiographs, with no signs of osteoarthritis or calcification. The best result can be obtained with early reduction, debridement, medial capsule and deltoid ligament restoration, and early rehabilitation. Clinical and radiographic features at long-term follow-up also confirm good mobility of the ankle without degenerative change or mechanical instability. (J Am Podiatr Med Assoc 98(6): 469–472, 2008)
Rhabdomyolysis is a debilitating condition that promotes muscle breakdown and eventually leads to renal dysfunction if not properly managed. The initial presentation may involve lower-extremity muscles, making the foot and ankle specialist one of the first specialists to recognize and diagnose this condition. Proper management of renal function is the primary concern; however, the underlying muscle breakdown needs to be addressed and the condition managed to prevent future problems. In this article we discuss treatment of a patient with exercise-induced rhabdomyolysis; a rehabilitation regimen is presented whose purpose is to condition muscles in order to prevent recurrence of exercise-induced muscle destruction after an acute event. (J Am Podiatr Med Assoc 97(3): 234–237, 2007)