A 19-YEAR-OLD teenager had a painless deformity on his right forefoot that developed slowly for 4 years when it began to interfere with shoe wearing, causing him to seek medical attention. On physical examination the right forefoot displayed some splaying with an unusually large second web space (Figure 1). Palpation revealed prominence of bony consistency between the bases of the second and third toes. Flexibility and mobility of the toes were normal, and no accompanying neurological signs were present. There was no other apparent deformity in the feet or body, and no family history of congenital or developmental skeletal deformities. Plain x-ray films show a bony outgrowth originating from the metaphysis of the proximal phalanx of the third toe on its medial (tibial) side, pushing the adjacent second toe away from its normal alignment into a varus position (Figure 2). Careful inspection of the roentgenogram revealed a small impression with a sclerotic rim on the lateral (fibular) side of the base of the proximal phalanx corresponding to the tip of the bony lesion. An excisional biopsy was performed, and the lesion was removed by osteotomizing it from the base of the phalanx. Figure 3 shows its macroscopic appearance; Figure 4, histological findings.
Accepted for publication March 18, 1999.
Reprints: Ilan Cohen, MD, Orthopaedic Department, Sheba Medical Center, Tel-Aviv University, 34 Kehilat-Zion St, Hertzlia 46382, Israel.
Cohen I, Chechick A, Heim M. Pathological Case of the Month. Arch Pediatr Adolesc Med. 2000;154(11):1163. doi:10.1001/archpedi.154.11.1163
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