[Luxatic pedis cum talo. (Clinical contribution based on 4 cases)].
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A 30-year-old woman with hereditary onycho-osteodysplasia was examined. In addition to the classic tetrad of fingernail and toenail dysplasia, patellar aplasia, iliac horns, and radial head hypoplasia and dislocation, she also had scoliosis, proteinuria, and distinctive bilateral foot anomalies. The foot deformity consisted of a ball-and-socket ankle joint, valgus ankle, forefoot supination, and lateral subluxation at the tarsal-metatarsal joints. The literature showed that the radiographic findings of foot deformity in this dysplasia have never been reported in detail before. Evidence suggests that this distinctive pattern of deformity may be more common than previously appreciated.
We present a case of tarsal tunnel syndrome caused by an amyloidoma arising from the talocalcaneal joint in a 64-year-old man with a long history of haemodialysis. He presented with numbness in the medial plantar area of the right foot without any antecedent trauma. The numbness was minimal at rest but gradually worsened, causing difficulty, when walking. Paraesthesia was present on the medial sole of the right foot. A positive Tinel-like sign was noted 2.5 cm below the medial malleolus. Magnetic resonance imaging demonstrated a round lesion, 1 cm in diameter, in the calcaneus, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. In addition, a mass, 1 cm in diameter with a signal isointense to that of muscle was found adjacent to the talocalcaneal joint. The medial plantar nerve was decompressed after removing a solid, 1-cm diameter mass from the talocalcaneal joint. At 6 months post surgery, the numbness had completely resolved. No recurrence was observed at the 24-month follow-up.
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Midfoot injuries of children are rare entities and often caused by high energy trauma mechanisms. Foot fractures in children may pose a diagnostic challenge but they usually have a good prognosis. In special cases computed tomography is necessary to find the right diagnosis in addition to plain X-rays. Based on two cases of midfoot injuries, a type II open Lisfranc fracture dislocation and a dislocation of a Chopart's joint, we describe the causes, diagnosis, and possibilities for treatment of juvenile midfoot injuries.
A case of fracture-dislocations of the hip, knee and tarsometatarsal joints in the same limb is presented. This combination of injuries has not previously been reported. There were no associated neurovascular complications.
A new physical sign (the 'toe up' sign) is described in relation to an irreducible Lisfranc injury, the cause being the interposed lateral slip of the tibialis anterior tendon. Surgical exploration is advocated.