From the Foot and Ankle Service, the Orthopaedic Department, Sheba Medical Center, Tel-Hashomer, Israel.
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.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Pediatrics editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.