Search Results
Calcifying Aponeurotic Fibroma of the Hallux
A Case Report
Calcifying aponeurotic fibroma is a rare benign fibrous tumor predominantly seen in children and adolescents younger than 20 years. This tumor is often treated with complete surgical excision, although the recurrence rate is approximately 50%. The distal upper and distal lower extremities are most commonly involved, with only three cases published to date involving pedal digits. We discuss a case of calcifying aponeurotic fibroma in a 25-year-old woman localized to the medial aspect of the distal hallux. Clinical, radiographic, and magnetic resonance imaging findings are described. After an incisional biopsy and histopathologic findings confirmed that the lesion was benign, a complete excision was performed, and diagnosis was established for calcifying aponeurotic fibroma. At 6 months, the patient had healed uneventfully, and no recurrence has been noted. Malignant transformation is rare but has been documented, warranting concern for clinicians and patients.
Epidermoid cysts of the sole of the foot are rare lesions that must be differentiated from other, more common subcutaneous pathologic abnormalities located on the sole. Cases of epidermoid cysts that extend to the interosseous musculature are rarer still. We report the case of a giant epidermal cyst in a 64-year-old individual that extended to the intrinsic musculature of the third space of the right foot and that was diagnosed after fine-needle aspiration biopsy and subsequent cytologic study. Differential diagnosis of these lesions should be made with the support of additional imaging tests, and diagnostic confirmation should always be obtained after surgical removal and subsequent histopathologic study.
Synovial Sarcoma of the Foot
A Case Report
We report a case of a 40-year-old woman with synovial sarcoma who presented with neural symptoms in the medial aspect of the right foot and ankle. The radiographic appearance of the foot and ankle was unremarkable, but magnetic resonance imaging showed a relatively well-defined enhancing lesion in the plantar soft tissues extending from the master knot of Henry to the posterior tibialis tendon. After orthopedic oncologic evaluation and workup, the patient was ultimately treated with a transtibial amputation, and no evidence of recurrence or metastatic disease was seen at 6-month follow-up. (J Am Podiatr Med Assoc 100(3): 216–219, 2010)
It is accepted that immunosuppressant therapy after organ transplantation is associated with an increase risk of neoplasm. Subungual squamous cell carcinoma of the toe is a rare condition and has not previously been reported, to our knowledge, in patients undergoing immunosuppressant therapy. The objective of this case study is to report the clinical and histopathologic findings and the multidisciplinary treatment approach for a case of subungual squamous cell carcinoma of the toe in an organ transplant recipient undergoing immunosuppressant drug therapy. (J Am Podiatr Med Assoc 100(4): 304–308, 2010)
Central Talar Dome Lesions
A Unique Surgical Approach with Incorporation of a Talar Allograft for Joint Reconstitution and Restoration of Function
Osteochondral lesions of the talus have been documented, reported, and studied since as early as the 19th century. The evolution of classification systems has allowed surgeons to better manage osseous lesions. Most osteochondral lesions of the talus have been categorized as anterolateral, posteromedial, or central with respect to the talar dome and its articulating surface. The complexity of the aforementioned lesions each present their own set of obstacles and, hence, management. Specifically, surgery on a central talar dome lesion is complicated by poor exposure and limited access, proving to be a challenging operation. Preoperative planning, including exhaustive imaging before any talar dome surgery, is imperative. We present a case study that involves the need for a distal tibial chevron (wedge) talus, with incorporation of a cadaveric allograft to fill the defect. (J Am Podiatr Med Assoc 101(2): 192–195, 2011)
Delayed Surgical Reconstruction of a Peroneal Tendon Rupture in an Accessory Os Peroneum
A Rare Differential Diagnosis in Chronic Ankle Pain
A fracture of the os peroneum is a rare cause of ankle and foot pain and is often overlooked and not assumed. Only a few case reports have discussed the different etiologies, options for diagnosis, and therapeutic interventions for acute cases. We present a case of delayed diagnosis of an os peroneum fracture due to a distortion of the ankle that occurred during air sports. Initial diagnostic testing with magnetic resonance imaging demonstrated a rupture of the peroneus longus tendon with no pathologic abnormalities at the peroneus brevis tendon. During surgery, a combination of an os peroneum fracture and a peroneus brevis tendon split was found and was successfully treated with bone and tendon repair using a lasso stich technique.
Proximal fibular stress fractures are rare injuries that usually result from jumping and running activities of military recruits and athletes. This article describes a female university athlete with proximal lateral leg pain diagnosed by means of a triphase bone scan as proximal fibular stress fracture and proximal to middle one-third tibial stress fracture. This case highlights the need to examine not only the sport but also the athlete’s training habits to identify possible factors contributing to the injury. Body type, biomechanics, and gender are also possible etiologic factors. (J Am Podiatr Med Assoc 93(4): 340-343, 2003)
Acute Charcot Foot Changes versus Osteomyelitis
Does Tc-99m HMPAO Labeled Leukocytes Scan Differentiate?
Osteomyelitis often complicates a diabetic neuropathic foot, leading to amputation, decreased function, and quality of life. Therefore, early detection and treatment are paramount. Furthermore, neuroarthropathic (Charcot) changes in the foot often resemble infection and must be differentiated. Currently, the Tc-99m HMPAO Labeled Leukocytes Scan is considered to be the most reliable noninvasive imaging modality of choice in determining Charcot foot changes versus osteomyelitis. The purpose of this article is to alert the clinician that although the Tc-99m HMPAO Labeled Leukocytes Scan may be the second most reliable test next to bone biopsy for determining osteomyelitis, false positives do occur. (J Am Podiatr Med Assoc 91(7): 365-368, 2001)
Simultaneous pancreas-kidney transplant (SPKT) is an accepted approach and the treatment of choice in patients with type 1 diabetes with accompanying end-stage renal disease. Charcot's neuroarthropathy of the foot (CN) is a fairly common and devastating complication found in patients with long-standing, mostly uncontrolled, diabetes. However, CN has also been identified as a posttransplant consequence of SPKT. Traditional postoperative immunosuppressive therapy, particularly the use of corticosteroids, is acknowledged as an additional risk factor for the development of de novo CN after SPKT. This article describes an unusual case of a patient who presented with full-blown CN deformity after SPKT.
This case study presents a novel technique of end-to-end implantation of cadaver graft for the repair of a complete transversely torn peroneus brevis tendon and partially torn peroneus longus tendon in a 58-year-old woman with chronic lateral ankle instability and associated lateral collateral tears. She had a history of multiple ankle sprains and had previously undergone a failed peroneus brevis tendon retubularization procedure. The use of cadaver graft is well documented in the literature for tendon repairs but not well documented in end-to-end repair of the peroneal tendons. A review of the literature revealed only one 2013 study reporting on the benefits and clinical outcomes of cadaver allograft use in peroneal reconstruction.
