Microgeodic Disease Affecting the Toes

Craig Payne · Mar 7, 2008

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I got one of my new publication alerts today and it was this:

Microgeodic Disease Affecting the Toes in Athletes: A Report of 2 Cases
Kashiwa et al. Am J Sports Med.2008
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I had not heard of this before and was intrigued....unfortunatly the article is not available as full text to non-subscribers and there was no abstract. SO, i did a search and found these:

Orthopedics & Traumatology
VOL.54;NO.1;PAGE.147-150(2005)
Microgeodic disease was first described by Moroteaux in 1970. We report a 7-year-old girl, who had swelling and redness in her right index, ring and left small fingers. Radiographs showed osteolytic lesion in the middle phalanges. Pathological fracture of the middle pharanx occurred in the right index six weeks after onset. Clinical symptoms and radio-graphic findings subsided in sixteen weeks. One year later she showed the same symptoms in her right middle finger. Due to spontaneous healing, prognosis is excellent for this disease. However, careful follow-up is necessary because pathological fractures, mal-alignment of fingers, and recurrence have been reported.
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Japanese Journal of Dermatology
VOL.114;NO.2;PAGE.169-172(2004)
A case of phalangeal microgeodic disease is reported. A 6-year-old-girl had chilblain-like symptoms, such as spindle-shaped swelling and redness on the left middle finger. This case was diagnosed as phalangeal microgeodic disease by the clinical manifestations and plain radiographic findings. At follow-up five months later, the swelling had almost resolved and only a deformity of the middle phalanx of the left middle finger was observed without any dysfunction. It is known that this disease is self-limiting and no therapy is needed. However epiphyseal damage has been reported in some cases. It is very important to follow up patients with this disease carefully
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Google Scholar search results on microgeodic disease

NewsBot · Sep 7, 2013

Chilblains and microgeodic disease diagnosed concurrently in a child's toe.
Prindaville B, Antaya RJ.
Pediatr Dermatol. 2013 Mar-Apr;30(2):269-70.

Microgeodic disease, similar to chilblains (pernio), is characterized by painful, erythematous swelling, as well as small, punched-out erosions found in affected phalanges. Although they share a similar appearance and proposed pathogenesis, chilblains has rarely been diagnosed in children with microgeodic disease, and in those cases has not been confirmed on skin biopsy. This article details a child in Connecticut diagnosed during the winter with chilblains and microgeodic disease of his toe, as supported by biopsy and imaging. These findings further indicate that the two diseases are interrelated, imply a similar pathogenesis, and lead us to suggest similar treatment for problematic forms of both diseases.
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NewsBot · Oct 22, 2016

Microgeodic Disease Affecting the Fingers and Toes in Childhood: A
Case Report
Tomonori Tetsunaga, Hirosuke Endo, Kazuo Fujiwara, Tomoko Tetsunaga and Toshifumi Ozaki
The Open Orthopaedics Journal, 2016, Volume 10 501 (full text)

Microgeodic disease is a disease of unknown etiology that affects the fingers and toes of children, with ≥ 90% of cases
involving the fingers alone. We present a rare case of microgeodic disease affecting an index finger and two toes simultaneously in a
7-year-old girl. X-ray and magnetic resonance imaging (MRI) showed multiple small areas of osteolysis in the middle phalanges of
the left index finger, hallux, and second toe. Microgeodic disease was diagnosed from X-ray and MRI findings, and conservative
therapy involving rest and avoidance of cold stimuli was provided. Although pathological fractures occurred in the course of
conservative treatment, the affected finger healed under splinting without any deformity of the finger.
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NewsBot · Jan 21, 2017

Diffuse phalangeal signal abnormality on magnetic resonance imaging: phalangeal microgeodic disease
Authors
Rupa Radhakrishnan et al
Pediatric Radiology 18 January 2017

Background
Phalangeal microgeodic disease is a rare and benign self-limited condition involving the phalanges, often in the setting of cold exposure, with characteristic MR imaging abnormalities. Radiographic case descriptions are predominantly from Asia and Europe, with only seven cases using MR to characterize phalangeal microgeodic disease.

Objective
In this study we describe the MR imaging appearance of unusual and striking phalangeal signal abnormality compatible with phalangeal microgeodic disease at our institution in North America.

Materials and methods
We retrospectively reviewed cases presenting at our institution with unusual or unexplained phalangeal signal abnormalities between 2001 and 2014. We reviewed the MR imaging appearances in conjunction with radiographs and any other available imaging investigations.

Results
Of 189 examinations reviewed during the study period, 8 imaging studies in 6 patients met the study inclusion criteria. Signal abnormality was present in 57 of 112 phalanges (51%), frequently involving the distal phalanges (70%, 28 of 40), followed by the middle phalanges (56%, 18 of 32) and the proximal phalanges (28%, 11 of 40). The pattern of involvement was most commonly diaphysis (38%), followed by metaphysis (32%) and epiphysis (30%). The extent of MR signal abnormality was greater than that suspected based on clinical presentation or on radiographs.

Conclusion
The presence of unexplained diffuse characteristic marrow involvement of multiple painful phalanges on MR images, often in the setting of cold exposure, should raise the possibility of phalangeal microgeodic disease. Consideration of this diagnosis based on MR findings would lead to a more conservative management and avoid unnecessary invasive diagnostic procedures.
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