The acute rupture of the tibialis posterior (TP) tendon, compared to an acute rupture of the Achilles tendon, is a quite uncommon disease to be diagnosed in the emergency department setting. In most cases symptoms related to a TP dysfunction, like weakness, pain along the course of the tendon, swelling in the region of the medial malleolus, and the partial or complete loss of the medial arch with a flatfoot deformity precede the complete rupture of the tendon. In this case report, we describe an acute rupture of the TP tendon following a pronation-external rotation injury of the ankle with no association of a medial malleolus fracture and with no history of a prior flatfoot deformity or symptoms.
Fracture-dislocations of the tarsal navicular are rare and highly complex injuries to the midfoot. The only published data on this type of fracture are clinical case reports. These injuries are normally caused by high-energy trauma, and their pathophysiology and most appropriate treatment remain unclear. We report a clinical case of a dorsal fracture-dislocation of the tarsal navicular bone associated with a medial swivel dislocation of the Chopart joint caused by a bicycle fall in a 20-year-old healthy man. Open reduction and percutaneous pinning in a novel arrangement was performed, with an excellent outcome 18 months after the injury.
An unusual case of solitary benign schwannoma of the foot is presented. Clinical examination, magnetic resonance imaging, and intraoperative findings all confirm the suspicion of a ganglion cyst. After attempted aspiration failed to produce any aspirate, excisional biopsy was performed. The pathology report confirms schwannoma with hematoxylin and eosin stain and subsequently reaffirmed with positive S100 protein stain. Even though schwannoma of the foot had been reported in the literature, this was an unusual case, as the lesion was presented as a superficial, ganglion cyst–like lesion on the bottom of the foot.
Pyoderma gangrenosum is a skin disease characterized by wounds with blue-to-purple undermined borders surrounding purulent necrotic bases. This article reports on a patient with a circumferential, full-thickness, and partially necrotic lower-extremity ulceration of unknown etiology. Results of laboratory tests and arterial and venous imaging studies were found to be within normal limits. The diagnosis of pyoderma gangrenosum was made on the basis of the histologic appearance of the wound tissue after biopsy as a diagnosis of exclusion. Negative pressure wound therapy was undertaken, which saved the patient’s leg from amputation. Although negative pressure wound therapy has demonstrated efficacy in the treatment of chronic wounds in a variety of circumstances, this is the first documented use of this technique to treat an ulceration secondary to pyoderma gangrenosum. (J Am Podiatr Med Assoc 95(2): 171–174, 2005)
Superficial acral fibromyxoma is a rare, benign, slow-growing, soft-tissue tumor commonly located in the acral regions, with a predilection for the great toe, developing from the nail unit. Because of its nonspecific features and rarity, clinical diagnosis is difficult. In this article, we present a case of superficial acral fibromyxoma located in the nail unit with new dermatoscopic and radiologic findings that have not been previously reported in the literature.
A schwannoma is a benign tumor with a neurogenic origin that affects peripheral nerves. It arises from the neural sheath of the peripheral nerves. We present a case of a 54-year-old woman who presented to our clinic with a painful schwannoma of her superficial peroneal nerve at the level of the ankle. The patient was treated with surgical excision, and diagnosis was confirmed with pathologic analysis.
The Bosworth ankle fracture-dislocation is a rare injury and is often irreducible because of an entrapped proximal fragment of the fibula behind the posterior tibial tubercle. Repeated closed reduction or delayed open reduction may result in several complications. Thus, early open reduction and internal fixation enable a better outcome by minimizing soft-tissue damage. We report on a 27-year-old man who underwent open reduction and internal fixation after multiple attempts at failed closed reduction, complicated by severe soft-tissue swelling, rhabdomyolysis, and delayed peroneal nerve palsy around the ankle.
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.
Perniosis, or chilblain, is an uncommon condition of the acral skin. Presented herein is a case report of a 65-year-old otherwise healthy construction worker with perniosis. He had a 3-year history of lesions on the fingers and toes brought on by cold, damp weather. On initial presentation, a biopsy sample was taken of a hallux lesion, and the patient was given a trial course of nifedipine therapy. Follow-up at 3 weeks showed complete relief of symptoms with nifedipine use, and the biopsy results confirmed the diagnosis. The etiology and pathogenesis of perniosis are reviewed. Differential diagnoses and treatment options are reviewed and discussed. Nifedipine therapy has been shown to be effective and should be considered the standard of care in the treatment of perniosis along with avoidance of cold, damp environments, with protection using gloves and warm socks.
The most common type of non-Hodgkin’s lymphoma is the B-cell type. We report herein a type of B-cell lymphoma in an adult ankle. A 63-year-old woman presented with a painful growth on the anteromedial aspect of her right ankle that was later diagnosed as a form of non-Hodgkin’s lymphoma. Clinically, the single mass appeared bluish in color, painful on palpation, and warm to the touch. The overlying skin was friable, and the lesion did not transilluminate. Histopathologic examination revealed a diffuse large B-cell lymphoma of germinal center origin on surgical excision. This case report focuses on the clinical presentation, surgical intervention, and overall outcome of a rare case of lymphoma of the ankle. (J Am Podiatr Med Assoc 100(6): 505–510, 2010)