Journal of Foot and Ankle Research
Contribution of magnetic resonance imaging in the diagnosis of talus skip metastases of Ewing's sarcoma of the calcaneus in a child
Introduction
Ewing's sarcoma of the calcaneus is rare. About thirty cases with calcaneus involvement have been reported in the literature. Talus skip metastases have rarely been described in the available literature
Case presentation
We report a case of a 14-year-old Moroccan boy, who presented with Ewing's sarcoma of his right calcaneus, diagnosed by swelling of the calcaneus evolving over a year. Radiography, computed tomography and magnetic resonance imaging showed an important tumoral process of the calcaneus and talus skip metastases. The diagnosis was confirmed with histology after a biopsy. In spite of amputation and postoperative chemotherapy, our patient died six months later due to secondary respiratory distress after lung metastasis.
Conclusion
Imaging, especially magnetic resonance, is important in the diagnosis of Ewing sarcoma and skeletal skip metastases. Treatment of Ewing's sarcoma consists of chemotherapy, radiation therapy and surgical resection depending on the stage and extent of the disease. With the exception of lesions in the calcaneus, the prognosis for disease-free survival of Ewing's sarcoma of the foot is excellent.
Posted by Hylton Menz at 13:21 Comments (0)
Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report
J Med Case Reports 2011 Aug 19;5(1):397. [Epub ahead of print]
Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report
Falidas E, Rallis E, Bournia KV, Mathioulakis S, Pavlakis E, Villias C.
ABSTRACT
Gout is a common inflammatory arthritis caused by articular precipitation of monosodium urate crystals. It usually affects the first metatarsophalangeal joint of the foot and less commonly other joints, such as wrists, elbows, knees and ankles. We report the case of a 75-year-old Caucasian man with tophaceous multiarticular gout, soft-tissue involvement and ulcerated tophi on the first metatarsophalangeal joint of the left foot, on the first interphalangeal joint of the right foot and on the left thumb. Ulcers due to tophaceous gout are currently uncommon considering the positive effect of pharmaceutical treatment in controlling hyperuricemia. Surgical treatment is seldom required for gout and is usually reserved for cases of recurrent attacks with deformities, severe pain, infection and joint destruction.
Posted by Hylton Menz at 19:00 Comments (0)
Solid variant of aneurysmal bone cyst of the heel
Solid variant of aneurysmal bone cyst of the heel: a case report
Journal of Medical Case Reports 2011, 5:145doi:10.1186/1752-1947-5-145
Abstract
Introduction
An aneurysmal bone cyst is a benign but often rapidly expanding osteolytic multi-cystic osseous lesion that occurs as a primary, secondary, intra-osseous, extra-osseous, solid or conventional lesion. It frequently coexists with other benign and malignant bone tumors. Although it is considered to be reactive in nature, there is evidence that some aneurysmal bone cysts are true neoplasms. The solid variant of aneurysmal bone cyst is a rare subtype of aneurysmal bone cyst with a preponderance of solid to cystic elements. Such a case affecting the heel, an unusual site, is reported.
Case presentation
A 26-year-old Caucasian man presented with pain and swelling in his left lower extremity. A plain radiograph demonstrated an intra-osseous, solitary, eccentric mass in the front portion of the left heel. Computed tomography and magnetic resonance imaging scans showed that the lesion appeared to be sub-cortical, solid with a small cystic portion without the characteristic fluid-fluid level detection but with distinct internal septation. Bone images containing fluid-fluid levels are usually produced by aneurysmal bone cysts. The fluid-fluid level due to bleeding within the tumor followed by layering of the blood components based density differences, but it was not seen in our case. An intra-lesional excision was performed. Microscopic examination revealed fibrous septa with spindle cell fibroblastic proliferation, capillaries and extensive areas of mature osteoid and reactive woven bone formation rimmed by osteoblasts. The spindle cells had low mitotic activity, and atypical forms were absent. The histological features of the lesion were consistent with the solid variant of an aneurysmal bone cyst.
Conclusion
Solid aneurysmal bone cysts have been of great interest to pathologists because they may be mistaken for malignant tumors, mainly in cases of giant cell tumors or osteosarcomas, because of cellularity and variable mitotic activity. It is rather obvious that the correlation of clinical, radiological and histological findings is necessary for the differential diagnosis. The eventual diagnosis is based on microscopic evidence and is made when a predominance of solid to cystic elements is found. The present case is of great interest because of the nature of the neoplasm and the extremely unusual location in which it developed. Pathologists must be alert for such a diagnosis.
Posted by Hylton Menz at 03:34 Comments (0)
Gas gangrene and osteomyelitis of the foot in a diabetic patient treated with tea tree oil
Gas gangrene and osteomyelitis of the foot in a diabetic patient treated with tea tree oil
International Journal of Emergency Medicine 2011, 4:14
Abstract
Diabetic foot wounds represent a class of chronic non-healing wounds that can lead to development of soft tissue infections and osteomyelitis. We reviewed a case of a 44-year-old female with a diabetic foot wound who developed gas gangrene while treating her wound with tea tree oil, a naturally derived antibiotic agent. This case report includes images that represent clinical examination and x-ray findings of a patient who required broad-spectrum antibiotics and emergent surgical consultation. Emergency Department (ED) detection of these complications may prevent loss of life or limb in these patients.
Posted by Hylton Menz at 03:26 Comments (0)
Case report: Macrodystrophia lipomatosa resulting in gigantism of toe
Macrodystrophia lipomatosa: four case reports
Italian Journal of Pediatrics 2010, 36:69doi:10.1186/1824-7288-36-69
Aim
Macrodystrophia lipomatosa is a rare cause of gigantism of limb which can be confused with other common causes like congenital lymphedema. It presents usually with loss of function and cosmetic problems. Four cases are described with emphasis on clinical presentation, differential diagnoses, imaging and treatment options.
Methods and Results
Four patients of macrodystrophia lipomatosa were thoroughly examined and subjected to investigations.
Conclusion
Besides diligent clinical examination, imaging and histopathology are crucial in clinching the diagnosis.
Posted by Hylton Menz at 06:01 Comments (0)
Case report: Remission of restless legs syndrome following neuroma surgery
Journal of Medical Case Reports 2010, 4:306doi:10.1186/1752-1947-4-306
| Published: | 17 September 2010 |
Abstract (provisional)
Introduction
Restless legs syndrome is a sensorimotor neurological disorder characterized by an urge to move the legs in response to uncomfortable leg sensations. While asleep, 70 to 90 percent of patients with restless legs syndrome have periodic limb movements in sleep. Frequent periodic limb movements in sleep and related brain arousals as documented by polysomnography are associated with poorer quality of sleep and daytime fatigue. Restless legs syndrome in middle age is sometimes associated with neuropathic foot dysesthesias. The causes of restless legs syndrome and periodic limb movements in sleep are unknown, but the sensorimotor symptoms are hypothesized to originate in the central nervous system. We have previously determined that bilateral forefoot digital nerve impingement masses (neuromas) may be a cause of both neuropathic foot dysesthesias and the leg restlessness of restless legs syndrome. To the best of our knowledge, this case is the first report of bilateral foot neuromas as a cause of periodic limb movements in sleep.
Case presentation
A 42-year-old Caucasian woman with severe restless legs syndrome and periodic limb movements in sleep and bilateral neuropathic foot dysesthesias was diagnosed as having neuromas in the second, third, and fourth metatarsal head interspaces of both feet. The third interspace neuromas represented regrowth (or 'stump') neuromas that had developed since bilateral third interspace neuroma excision five years earlier. Because intensive conservative treatments including repeated neuroma injections and various restless legs syndrome medications had failed, radical surgery was recommended. All six neuromas were excised. Leg restlessness, foot dysesthesias and subjective sleep quality improved immediately. Assessment after 18 days showed an 84 to 100 percent reduction of visual analog scale scores for specific dysesthesias and marked reductions of pre-operative scores of the Pittsburgh sleep quality index, fatigue severity scale, and the international restless legs syndrome rating scale (36 to 4). Polysomnography six weeks post-operatively showed improved sleep efficiency, a marked increase in rapid eye movement sleep, and marked reductions in hourly rates of both periodic limb movements in sleep with arousal (135.3 to 3.3) and spontaneous arousals (17.3 to 0).
Conclusion
The immediate and near complete remission of symptoms, the histopathology of the excised tissues, and the marked improvement in polysomnographic parameters documented six weeks after surgery together indicate that this patient's severe restless legs syndrome and periodic limb movements in sleep was of peripheral nerve (foot neuroma) origin. Further study of foot neuromas as a source of periodic limb movements in sleep and as a cause of sleep dysfunction in patients with or without concomitant restless legs syndrome, is warranted.
Posted by Hylton Menz at 19:25 Comments (0)
A severe case of erythrodermic psoriasis associated with advanced nail and joint manifestations
Carlos G Teran , Carlos N Teran-Escalera and Carola Balderrama
Journal of Medical Case Reports 2010, 4:179doi:10.1186/1752-1947-4-179 Published: 15 June 2010
Abstract (provisional)
Introduction Erythrodermic psoriasis is a rare generalized clinical presentation of psoriasis in children and adults. Its systemic involvement and a diverse range of clinical findings in the joint and nails are commonly described. A high index of suspicion and an exhaustive differential diagnosis involving other causes of erythroderma should be initially considered.
Case presentation We present the case of a 9-year-old native Hispanic girl with severe erythrodermic psoriasis associated with uncommon advanced nail and joint manifestations. Our patient showed an excellent response to methotrexate medication.
Conclusion This case shows clinical features not commonly described or reported in severe cases of erythrodermic psoriasis, including severe and rare nail and arthritic findings in a pediatric scenario.
Posted by Hylton Menz at 03:09 Comments (0)
Small cell osteosarcoma of a toe phalanx: a case report
Small cell osteosarcoma of a toe phalanx: a case report and review of literature
Journal of Orthopaedic Surgery and Research 2010, 5:36doi:10.1186/1749-799X-5-36
Abstract (provisional)
This report describes the radiological and histological findings of a small cell osteosarcoma of a toe phalanx in a 38 year old man. This man presented with pain, swelling and redness of the left third toe. Medical history revealed an osteomyelitis of this toe eight years prior. Based on clinical findings and medical history the lesion was diagnosed as an osteomyelitis. However, peroperatively the lesion had a malignant aspect. Histological examination revealed a small cell osteosarcoma of the proximal phalanx. Osteosarcoma of the foot and especially of the tubular bones is rare. Moreover small cell osteosarcoma is a rare subtype of osteosarcoma. This case demonstrates that medical history and clinical examination can be misleading. In patients with apparent bone destruction, a malignancy must always be excluded prior to treatment. It emphasises the care that should be taken in the process of formulating a diagnosis.
Posted by Hylton Menz at 03:42 Comments (0)
Popliteal block for ankle arthrodesis: a case series
Popliteal block with transfibular approach in ankle arthrodesis: a case series
Journal of Medical Case Reports 2010, 4:135doi:10.1186/1752-1947-4-135
| Published: | 12 May 2010 |
Abstract (provisional)
Introduction
Ankle arthrodesis is primarily done for control of severe pain in the ankle joint. Immediate post-operative pain is usually treated using oral analgesics, intravenous opiates and regional anaesthesia. Outcomes following ankle fusion including patient satisfaction studies are well documented in the literatures. However the advantage of popliteal block in the management of early post-operative pain after ankle fusion for osteoarthritis has not been widely reported. The purpose of this study was to determine the role of popliteal block in the management of ankle osteoarthritis, using ankle fusion.
Case presentation
Twenty-seven cases of ankle arthrodeses were performed on 26 patients over a 5year period. Eighteen were males (one had bilateral arthrodesis) and eight were females. Their mean age was 56years and they were all Caucasians. The notes and radiographs of the patients were retrospectively reviewed for duration of hospital admission, time to union and complications.
Conclusion
Popliteal block is a safe and effective technique for post-operative analgesia in ankle arthrodesis. We achieved a significant reduction in the duration of hospital stay after ankle arthrodesis by using this technique. The resultant cost saving was GBP717.00 for each patient.
Posted by Hylton Menz at 00:19 Comments (0)
Coexistence of Mal de Meleda and congenital cataract: two case reports
Bchetnia M, Merdassi A, Charfeddine C, Mgaieth F, Kassar S, Ouechtati F, Chouchene I, Boussen H, Mokni M, Osman AD, Boubaker MS, Abdelhak S, Elmatri L.
J Med Case Reports. 2010 Apr 20;4(1):108. [Epub ahead of print]
Abstract
ABSTRACT: INTRODUCTION: Mal de Meleda is a rare form of palmoplantar keratoderma, with autosomal recessive transmission. It is characterized by diffuse erythema and hyperkeratosis of the palms and soles. Recently, mutations in the ARS (component B) gene (ARS, MIM: 606119) on chromosome 8q24.3 have been identified in families with this disorder. Congenital cataract is a visual disease that may interfere with sharp imaging of the retina. Mutations in the heat-shock transcription factor 4 gene (HSF4; MIM: 602438) may result in both autosomal dominant and autosomal recessive congenital cataracts. CASE PRESENTATION: A Tunisian family with two female siblings aged 45 and 30 years, presented with a clinical association of mal de Meleda and congenital cataract. The two patients exhibited diffuse palmoplantar keratodermas. One of them presented with a total posterior subcapsular cataract and had a best corrected visual acuity at 1/20 in the left eye and with the right eye was only able to count fingers at a distance of one foot. The other woman had a slight posterior subcapsular lenticular opacity and her best corrected visual acuity was 8/10 in the right eye and with her left eye she was only able to count fingers at a distance of one foot. A mutational analysis of their ARS gene revealed the presence of the homozygous missense mutation C99Y and two single nucleotide polymorphisms (-55G>C and -60G>C). The splice mutation (c.1327+4A-G) within intron 12 of the HSF4 gene, which has been previously described in Tunisian families with congenital cataract, was not found in the two probands within this family. CONCLUSION: To the best of our knowledge, such original clinical association has not been reported previously. The association of these two autosomal recessive diseases might have occurred in this family due to a high degree of inbreeding. The C99Y mutation may be specific to the Tunisian population as it has been exclusively reported so far in only three Tunisian families with mal de Meleda.
Posted by Hylton Menz at 23:56 Comments (0)
Calcaneal osteomyelitis presenting with acute tarsal tunnel syndrome: a case report
Calcaneal osteomyelitis presenting with acute tarsal tunnel syndrome: a case report
Davinder PS Baghla , Sajid Shariff and Raman Dega
Journal of Medical Case Reports 2010, 4:66doi:10.1186/1752-1947-4-66 Published: 23 February 2010
Abstract (provisional)
Introduction Acute tarsal tunnel syndrome is rare. We describe the only reported case of acute posterior tibial nerve compression, arising as a result of adjacent haematogenous pyogenic calcaneal osteomyelitis.
Case presentation A previously fit 38-year-old Caucasian lady developed symptoms of acute tarsal tunnel syndrome in her right foot over a 6 day period. There was no antecedent trauma or systemic symptoms. MRI and bone scan imaging, followed by surgical decompression and bone biopsy confirmed a diagnosis of Staphylococcus Aureus calcaneal osteomyelitis. Her pain and paraesthesia disappeared post operatively, whereas her inflammatory markers normalised whilst on a 12 week course of antibiotics. At 4 years follow up she remains asymptomatic without recurrence.
Conclusion This case is not just unique in describing osteomyelitis as a cause of tarsal tunnel syndrome, haematogenous calcaneal osteomyelitis in itself is a rare pathology. We recommend considering infection as a differential diagnosis for acute tarsal tunnel syndrome.
Posted by Hylton Menz at 01:29 Comments (0)
Charcot foot reconstruction with combined internal and external fixation: case report
Charcot foot reconstruction with combined internal and external fixation: case report
Journal of Orthopaedic Surgery and Research 2010, 5:7doi:10.1186/1749-799X-5-7
Abstract (provisional)
Charcot neuroarthropathy is a destructive and often-limb threatening process that can affect patients with peripheral neuropathy of any etiology. Early recognition and appropriate management is crucial to prevention of catastrophic outcomes. Delayed diagnosis and subsequent pedal collapse often preclude successful conservative management of these deformities and necessitate surgical intervention for limb salvage. We review the current literature on surgical reconstruction of Charcot neuroarthropahty and present a case report of foot reconstruction with combined internal and external fixation methods.
Posted by Hylton Menz at 00:28 Comments (0)
Oligoarthritis of the foot following influenza B virus infection: case report
Transient oligoarthritis of the lower extremity following influenza B virus infection: case report
Abstract (provisional)
A 12-year-old girl developed influenza B virus infection proven by typical symptoms and detection of the virus in a nasopharyngeal swab by culture and PCR. Two weeks later she developed an otherwise unexplained transient oligoarthritis of small joints of the left foot. Influenza viruses may be a hitherto underappreciated cause of a post-infectious arthritis.
Posted by Hylton Menz at 22:06 Comments (0)
Tenosynovial giant cell tumors as accidental findings after episodes of distortion of the ankle: two case reports
Abstract
Tenosynovial giant cell tumors are benign tumors of uncertain pathogenesis. They occur in the joints, tendons and synovial bursas. Due to a high recurrence rate of up to 50%, some authors call a giant cell tumor a semimalignant tumor. To date, less than 10 cases of tenosynovial giant cell tumor of the ankle have been published in the international medical literature. In this case report, we present two patients with localized tumors that were detected accidentally after the occurrence of ankle sprains with persisting pain in the joint. The tumors were resected by open marginal surgery and regular follow-up examinations were carried out. We present an unusual occurrence of a tumor along with a possible follow-up strategy, which has not been previously discussed in the international literature.
Posted by Hylton Menz at 22:08 Comments (0)
Chronic bilateral heel pain in Sever's disease: case report
Chronic bilateral heel pain in a child with Sever disease: case report and review of literature
Fred C Sitati, and John Kingori
Abstract
We are presenting a case report of a 10-year-old male with a 1 year history of bilateral heel pain. Sever disease is self limiting condition of calcaneal apophysis. It is the most common cause of heel pain in the growing child. There is no documented case of this condition in this region. This case highlights the clinical features of this self limiting disorder as seen in this patient and reviews the current literature.
Posted by Hylton Menz at 05:14 Comments (0)