Functional hallux limitus is defined as a functional inability of the proximal phalanx of the hallux to extend on the first metatarsal head during gait. The theory concerning this anomaly and the altered gait characteristics that may result appears to have influenced the understanding of sagittal plane podiatric biomechanics. Although there is an increase in the body of evidence to support the proposed gait alterations, a detailed review suggests the need for further work. The aim of this article is to review the functional hallux limitus literature and its reported effects on gait. Furthermore, we explore some of the key and inherent problems with obtaining accurate data for joint motion measurement in the foot. With evidence-based practice now at the forefront of both clinical and academic practice, it is imperative to review the literature that underpins a particular commonly held or historical belief, in order to substantiate and validate subsequent diagnoses and treatments provided in light of this information. This is also true to advance the understanding of a particular anomaly or pathology and to inform so as to facilitate the provision of better care to patients. (J Am Podiatr Med Assoc 99(3): 236–243, 2009)
A case of tophaceous gout involving a foot sesamoid is described in a middle-aged man with a history of chronic gout. Microscopic findings consisting of tophaceous foci located beneath an intact hyaline articulating surface are correlated with associated radiographs. (J Am Podiatr Med Assoc 91(7): 379-380, 2001)
Solitary fibrous tumors are uncommon mesenchymal neoplasms that were initially described as pleural tumors, but in recent years, numerous extrapleural sites have been reported. A solitary fibrous tumor is characterized as a circumscribed, painless mass with a patternless growth pattern, positive CD34 spindle-shaped cells, bcl-2, and dense keloidal collagen with areas of hypercellularity and hypocellularity. This case report describes a 55-year-old male veteran who presented with a rare manifestation of an extrapleural solitary fibrous tumor of the medial right hallux. Microscopic and immunohistochemical findings were consistent with the previously documented characteristics of solitary fibrous tumors. Complete surgical excision of the tumor is the treatment of choice.
The authors review histologic findings from 50 cases of heel spur surgery for chronic plantar fasciitis. Findings include myxoid degeneration with fragmentation and degeneration of the plantar fascia and bone marrow vascular ectasia. Histologic findings are presented to support the thesis that “plantar fasciitis” is a degenerative fasciosis without inflammation, not a fasciitis. These findings suggest that treatment regimens such as serial corticosteroid injections into the plantar fascia should be reevaluated in the absence of inflammation and in light of their potential to induce plantar fascial rupture. (J Am Podiatr Med Assoc 93(3): 234-237, 2003)
We present a case of a 59-year-old male veteran with a chronic history of right foot soft-tissue mass that was causing pain in his shoes, but not functional or neurologic symptoms. Excision of the mass and pathologic evaluation resulted in multidisciplinary involvement and evaluation. In this example, the mass was found to be either an unusual schwannoma that happens to be psammoma body–rich or an unusual psammomatous melanocytic schwannoma that deviates from conventional examples, as a diagnostic consensus was unable to be reached. Schwannomas are an uncommon finding in the foot, and even more uncommon are those that contain psammoma bodies. Although rare, these tumors can be concerning for more systemic, life-altering diseases such as Carney complex, for which our patient refused genetic testing.
Soft-tissue chondroma is a rare, benign tumor. It is predominantly found in the hands and feet, but rarely in the toes. In this article, we report a digital soft-tissue chondroma that presented as a painful nodule of 5 years' duration in a 67-year-old man. Physical examination revealed a round, solid, movable nodule measuring 7 mm in diameter. Radiographs showed faint linear calcifications in the nodule under the right hallux proximal phalanx neck. The mass was completely excised, and pathologic observation revealed a mass composed of mature chondrocytes in a cartilaginous matrix, consistent with a chondroma. Even though this is a benign tumor, it needs to be differentiated from other tumors, including schwannoma, leiomyoma, chondrosarcoma, and others. Surgical excision is the preferred treatment.