Patient help: 7 years old, huge toe.

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Administrator, I do not know whether I can post the case on the forum to discuss. If I can not do it, please delete it . Thanks!!

the patient , 7 years old,huge toe.
How to treat it?

 

another photo

this is the photo for the patient.

 

The X ray photo

The X ray photo

 

The X ray photo

The X ray photo

 

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.

Good Luck

 

Any other possible 'genetic' related problems? Family history?
(Great case thanks for posting!)

 

Hello,

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)

Hildebrandt JW, Olson P, Paratainen H, Griffiths HJ. Macrodystrophia
lipomatosa. Orthopedics 16:1076–1077, 1993.

Kalen V, Burwell DS, Omer GE. Macrodactyly of the hands and feet. J Pediatr Orthop 8:311–315, 1988

Watt AJ, Chung KC. Macrodystrophia lipomatosa: a reconstructive approach to gigantism of the foot. J Foot Ankle Surg. 2004 Jan-Feb;43(1):51-5

Best of luck,

Lee

 

TO : 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.

Best regards.

Haibo Zou