Transient migratory osteoporosis of the foot

We report a case of transient osteoporosis of the foot with a clear migratory pattern of bone marrow oedema from the talus to navicular bone in the ipsilateral foot with evidence of complete clinical and radiographic resolution at 1 year with conservative measures.     

Osteomyelitis of the accessory navicular bone in the foot. A case report

The accessory navicular is one of the most symptomatic bones of the foot. Osteonecrosis and fracture of this bone have been previously described. We report a case of osteomyelitis of an accessory navicular bone in a young girl, to make treating clinicians aware of this rare possibility.     

Transient osteoporosis of hip in pregnancy.

Transient osteoporosis in pregnancy is a relatively rare disorder characterized by disabling pain in the hip without prior trauma and by striking radiographic evidence of osteopenia that is limited to the hip. Clinical and radiographic findings regress spontaneously within months after pregnancy and without late sequelae. In this study, we report on a case of a 28-yr-old Caucasian woman who suffered from transient osteoporosis during pregnancy. Nine months later, the patient was asymptomatic and there was resolution of the bone marrow edema pattern seen on the initial magnetic resonance imaging scan of her hip. Follow-up bone densitometry at 1 yr revealed a dramatic increase (12.3%) in bone mineral density of the symptomatic hip. We review the literature and discuss possible mechanisms involved in the pathogenesis of transient osteoporosis in pregnancy.     

Adult Flat Foot With Multiple Accessory Navicular Bones Treated Surgically: A Case Report and Review of the Literature

Multiple accessory navicular bones is an extremely rare condition. To the best of our knowledge, only 8 cases in 2 imaging studies have been published. We report a case of a patient with flat foot with 2 accessory navicular bones. This patient needed to be treated surgically, and the surgery was successful, with short-term follow-up. We believe this is the first case of multiple accessory navicular bones to be treated surgically in English literature. The incidence of multiple accessory navicular bones might be higher. There is a risk to remaining ossicles without resection or fixation during surgery; therefore, we strongly recommend using not only radiographs, but also 3-dimensional computed tomography scans or magnetic resonance imaging scans to confirm the type of accessory navicular bone, at least before surgery, for both painful accessory navicular bone and flat foot with accessory navicular bone.     

Osteoid osteoma of the tarsal navicular bone: an uncommon localization

We report a case of subchondral osteoid osteoma of the tarsal navicular bone. Osteoid osteomas are often located in the foot, mainly in the talus. This is the first report in the literature of a tarsal navicular bone localization. Diagnosis was difficult and established late due to misleading clinical presentation simulating mediotarsal arthritis.     

Transient osteoporosis of the talus

We report the case of a 60-year-old male who presented to the orthopaedic clinic with transient osteoporosis of the talus. Clinical and radiological findings, particularly MRI, were consistent with previous reports of this rare and poorly-understood condition. Interestingly, this patient presents with two separate but similar episodes of ankle pain documented over a 6-year period, and the suggestion is made of recurrence of transient osteoporosis in the same bone, with the severity of the recurring episode being notably greater than the initial one. The Mazur foot and ankle scoring system was used to assess function throughout this period of follow-up. Both episodes resolved over time with conservative management only, i.e. rest, elevation and simple (non-NSAID) analgesia. Transient osteoporosis is otherwise known as bone marrow oedema syndrome, although controversy surrounds its nomenclature and aetiology as a distinctive self-limiting disease.     

Vertical talus]

Authors differentiate four etiological groups of vertical talus. In their material the congenital and symptomatic rocker bottom foot was rarer than the paralytic one. Good result can be expected mainly from the operative treatment. From 69 cases good clinical and radiological result was reached in 58, whereas in 6 cases the treatment had no result. It was their experience that a reduction of the talus and of the navicular bone can be reached by tenotomies and capsulotomies and by these a normal form of the foot can be secured. In the conservation of the operative results the significance of the organized care is stressed.     

Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis

Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient who revealed bilateral hip pain during early postnatal period. The plain radiographs and computarized tomography showed bilateral femoral neck and asetabular fractures. The diagnosis of osteoporosis was established by bone mineral density. Diagnostic work-up excluded a secondary osteoporosis. The case was treated successfully by bilateral cementless total hip arthroplasty. Bone mineral density increased after 2 years of treatment with calcium–vitamin D, calcitriol and alendronate. Diagnosis of pregnancy-associated osteoporosis should be suspected when hip pain occurs during pregnancy or in the post-partum period as it can lead to acetabular and femoral neck fractures.     

Transient regional osteoporosis: A rare cause of foot and ankle pain

Transient regional osteoporosis is a rare, self-limiting condition. It can primarily affect the foot and ankle and should be considered in the differential diagnosis of patients with acute foot and ankle pain. We report three cases, which illustrate the importance of recognizing the typical clinical and radiological features of transient osteoporosis of the foot and ankle, thereby allowing an appropriate form of management and obviating the need for more invasive investigations.     

The accessory navicular

The accessory navicular is a common presence in the human foot and must be included in the differential diagnosis of medial foot pain in patients who are of appropriate age. Imaging modalities aid in diagnosis of a symptomatic ossicle and guide classification and treatment. Often, a combination of studies is needed to establish an accessory navicular as the source of foot pathology. Although conservative measures always are the first line of treatment, the benefits of surgical management are well-defined in the literature. Most foot surgeons rely on resection procedures with varied handling of the PTT insertion, although newer modifications that use bony fusion techniques are being investigated. As with any musculoskeletal condition, proper diagnosis and individually-tailored treatment plans are of the utmost importance to a satisfactory outcome. With meticulous patient selection and a thorough understanding of the condition, management of the painful accessory navicular often is successful in alleviating the disability it causes.     

Les os surnuméraires des tarses : cause inhabituelle de douleur de la cheville : à propos de quatre cas

Introduction

Supernumerary or accessory tarsal bones result from a failed fusion between the ossific nucleus and adjacent bone. It occurs rarely and is usually asymptomatic. The supernumerary bones can become symptomatic particularly following traumatism or in athletes.

Materials and Methods: Results

We report four demonstrative illustrations of supernumerary tarsal bones resembling a sprained ankle. Our patients are three male athletes (two footballers and a karate black belt) and a female basketball player. The mean age of our patients was 22 years (20–24 years). The accessory bones were os trigonum in two cases, an accessory navicular bone in one case and an os peroneum in the last. Posterior foot pain, after a traumatism, resembling a sprained ankle, was the major symptom in our athletes. Radiological investigations have an important place in the diagnosis of these supernumerary bones. After medical treatment, our patients described a spectacular improvement in their symptoms. Twenty-two months later, our patients had regained their high-level sporting activities.

Conclusion

Tarsal supernumerary bones can become symptomatic after an ankle traumatism and may resemble a sprained ankle. Radiological explorations can aid correct diagnosis. Conservative treatment is usually successful in such patients. Surgical management is reserved for when conservative methods fail.     

Inheritance of the accessory navicular bone

The accessory navicular bone is one of the most symptomatic bones of the foot. Although it has been reported to be present in various members of the same family, there is a lack of knowledge about its inheritance in the literature. We examined three families and suggest that it has an autosomal dominant trait with incomplete penetrance. Received: 4 August 1999     

Bipartite os tibiale externum: A rare condition causing foot pain

BackgroundThe accessory navicular (os tibiale externum, prehallux) is a frequent skeletal variation. However, a bipartite os tibiale externum is extremely rare and so far has only be reported in radiologic studies.MethodsWe report on a 30-year old female patient with flexible flatfoot and a bilateral accessory navicular. On the more painful side, a bipartite accessory navicular was resected. The posterior tibial tendon was fixed to the medial aspect of the navicular proper after levelling the prominent tuberosity.Results and conclusionsThe patient was completely pain free after 6 weeks and there was no remaining functional deficit. Bipartite accessory navicular is a very rare variant of a rather frequent accessory bone at the foot. Resection of the ossicle with debridement of the medial aspect of the navicular and attachment of the posterior tibial tendon to the navicular body (modified Kidner procedure) seems to lead to an excellent result also in these cases. In the presence of more severe deformities, treatment has to be adapted to the individual case.     

Fractures of the body of the tarsal navicular bone: case reports and literature review

Four patients sustaining tarsal navicular body fractures are presented. Analysis based on these cases and on 36 patients suffering from identical fractures reported in the literature led to a new mechanical assumption: the axial compression on the foot, as a result of falling from height, causes impaction of the talus into the body of the navicular bone. The clinical followup results reported are usually disappointing. Favorable results are obtained in a vertical two-part fracture, by an open reduction and internal fixation of the tarsal navicular body fracture. In highly comminuted fractures, talo-navicular-cuneiform arthrodesis can be carried out.     

Transient osteoporosis of the knee following trauma

Transient osteoporosis is an uncommon, self-limiting, reversible condition. We report a case involving the knee following trauma. The aetiology is unknown, but the association between transient osteoporosis and trauma has not been documented previously. The clinical presentation represents a degree of overlap among various clinical syndromes, including reflex sympathetic dystrophy and avascular necrosis. The diagnosis was confirmed by bone scan and MRI. The patient, a 47-year-old man, was treated with non-steroidal anti-inflammatory medication, protected weight-bearing and physiotherapy. He made a full clinical recovery and bone quality returned to virtual normality.     

Isolated dislocation of the tarsal navicular

An unusual case of isolated dorsal dislocation of the tarsal navicular bone due to hyperextension of the foot is presented. The treatment was closed reduction with percutaneous fixation with a Kirschner wire and immobilization for 8 weeks. The end result was satisfactory. To prevent redislocation leading to arthritis, the Kirschner wire should be left in place for at least 6 months.     

唑来膦酸盐与骨质疏松症

目的 双膦酸盐是目前抗骨质疏松治疗最常用药物.唑来膦酸盐是每年1次静脉注射用双膦酸盐,探讨唑来膦酸盐对骨质疏松的治疗作用及安全性分析.方法 PubMed上检索应用唑来膦酸盐治疗骨质疏松及其他疾病的相关文献并进行分析.结果 HORIZON-PFT 3年研究表明唑来膦酸盐与安慰剂比较,能明显降低椎体、非椎体骨折风险,增加骨密度,降低骨转换标志物水平,增加骨小梁容量.在90 d内行髋部骨折外科治疗的患者中进行的HORIZON-RFT研究发现唑来膦酸盐与安慰剂比较能够明显降低再发骨折风险,降低全因死亡率,增加髋部及股骨颈骨密度.绝经后低骨密度妇女从阿伦膦酸钠改为唑来膦酸盐3个月内平均骨转换标志物水平先下降,后逐渐增至绝经前妇女正常范围,且可维持腰椎骨密度值12个月.另一研究表明与阿伦膦酸钠比较,唑来膦酸盐能更迅速的降低骨吸收标志物,抑制骨吸收.在安全性方面唑来膦酸盐可能的副作用包括急性一过性不良反应,如发热、肌痛、流感样症状,主要为轻到中度,常发生在静脉输注后3 d内,3～7 d左右缓解.研究表明唑来膦酸盐短期内可能引起肾功能的变化,但长期对肾功能未发现明显影响.颌骨骨质疏松性坏死可能与唑来膦酸盐相关,但发生率较低,且多发生在恶性肿瘤如多发性骨髓瘤和转移癌的患者中,尚未证实颌骨骨质疏松性坏死风险增高与用于治疗骨质疏松症批准剂量的唑来膦酸盐有关.其他少见的副作用包括房颤,无症状及一过性低钙血症,尚需要大样本长期研究证实.结论 每年1次唑来膦酸盐是治疗绝经后骨质疏松新的选择.     

Significant Forefoot Varus Deformity Resulting in Progressive Stress Fractures of All Lesser Metatarsal Bones

Stress fractures may occur in any bone, but appear most frequently in the metatarsal bones. Consecutive stress fractures of all lesser metatarsals in a short period are rare, and only a few cases have been described in the literature. We report an unusual case of a young man with consecutive stress fractures of four adjacent lesser metatarsal bones. The etiology was in all probability the fixed forefoot varus deformity. This foot deformity may impose increased mechanical loads across the lateral aspect of the foot that, in turn, may result in stress fractures involving the lesser metatarsals. In our patient conservative treatment finally resulted in a satisfactory outcome.     

The accessory navicular and its association with flatfoot

BackgroundThe accessory navicular (os tibiale externum, prehallux) is a frequent skeletal variation. It may become symptomatic and is reported to be associated with flatfoot in children and adults.MethodsWe conducted an extensive review of the literature and reviewed the experience from two centers of foot and ankle surgery in Germany and the United States.Results and ConclusionsThe majority of accessory navicular ossicles is asymptomatic. Symptoms may arise from local pressure in shoewear, loosening of the connection to the navicular body as well as irritation and functional elongation of the tibialis posterior tendon (PTT). A symptomatic accessory navicular is frequently associated with flexible flatfoot. Resection of the ossicle with debridement of the medial aspect of the navicular and attachment of the PTT to the navicular body (modified Kidner procedure) leads to good and excellent results in about 80% of patients and some heightening of the arch mainly in adolescents. In more severe deformities, augmentation of the Kidner technique with fusion of the accessory navicular to the navicular proper, transfer of the flexor digitorum longus tendon, arthroereisis, osteotomies, calf gastrocnemius release and midfoot fusions have lead to favorable results in smaller series.