Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
You know, in looking at the x-ray, it appears there are only 4 metatarsals. I don't know if this is an artifact, or this is indeed the case.
Just by looking at it, there is a striking similarity to "lobster claw deformity", though this is often bilateral. Is there a family history? This is important since it is a recessive trait.
It appears that the growth centers are open, and ultimately surgical reconstruction will be the only option. Consider this after a full workup and appropriate scanning such as bone scan, and or MRI to evaluate any underlying pathology.
Any other possible 'genetic' related problems? Family history?
(Great case thanks for posting!)
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Looking at the DP view, there seems to be all 5 metatarsals present, it's the proximal phalanx of the 5th toe that's not as opaque (thanks Ian!) as the others.
Apologies for anyone who's seen a similar post on the socap site, but after much copying and pasting, could be pedal macrodactyly -
Overgrowth of soft tissue or bones in either focal or generalized distribution. According to Berquist (Radiology of the foot & ankle pp 467-8, citing Resnick, D. Diagnosis of Bone and Joint Disorders. 3rd Ed. Philadephia, WB Saunders, 1995), it can be either idiopathic or associated with hemangiomas, arteriovenous malformations, lymphangiomas, neurofibromatosis, epidermal nevus syndrome, proteus syndrome, Ollier's disease and macrodystrophia lipomatosa.
There's also a review and case study available in FAI -
Sobel E, Giorgini RJ, Potter GK, Schwartz RD, Chieco TM. Progressive pedal macrodactyly surgical history with 15 year follow-up. Foot Ankle Int. 2000 Jan;21(1):45-50
Macrodactyly can affect the fingers and/or toes 1. Histopathologic examination will distinguish macrodactylia fibrolipomatosis or neural fibrolipoma with macrodactyly, from macrodactylia as a part of neurofibromatosis. Surgical repair is aimed at decreasing the size of the affected foot so it is as near in size and shape to the normal foot as possible. Surgical approaches have included reconstructive surgery (usually staged debulking procedures), epiphyseal plate arrest and amputation. Repeated reconstructive surgical procedures, as illustrated in this report covering patient care over a 15 year period, are usually necessary due to recurring soft tissue and boney enlargement.
According to Watt & Chung (2004) (citing Kalen et al. (1988)) the incidence is "...0.035% of cases presenting to an active pediatric orthopaedic clinic."
Macrodystrophia lipomatosa is considered "...a congenital nonhereditary enlargement of all of
the mesenchymal elements in the distribution of the median or plantar nerves." (Hildebrandt et al. 1993)
Looking at the DP view, there seems to be all 5 metatarsals present, it's the proximal phalanx of the 5th toe that's not as opaque (thanks Ian!) as the others.
Apologies for anyone who's seen a similar post on the socap site, but after much copying and pasting, could be pedal macrodactyly -
Overgrowth of soft tissue or bones in either focal or generalized distribution. According to Berquist (Radiology of the foot & ankle pp 467-8, citing Resnick, D. Diagnosis of Bone and Joint Disorders. 3rd Ed. Philadephia, WB Saunders, 1995), it can be either idiopathic or associated with hemangiomas, arteriovenous malformations, lymphangiomas, neurofibromatosis, epidermal nevus syndrome, proteus syndrome, Ollier's disease and macrodystrophia lipomatosa.
Best of luck,
Lee :)
Thanks for reply.
If the patient to oprerate, you think how to do it?
I just want to cut the 3rd metatarsal and reconstruct the soft tissue.
Patient help: 7 years old, huge toe.
Linear Mode
