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Excerpt
HISTORY - This 40 year old female complained of right great toe pain for 4 months. She denied any antecedent trauma. She runs 35-40 miles per week, mostly on trails. She denied any recent change in shoe wear, running surface or mileage. Her pain occured daily, nightly, at rest and was fairly constant. She described it as intermittantly "extremely severe and sharp", and limiting her running. She denied swelling or skin changes. Her family physician treated her for "gout" with ibuprofen and a walking boot without improvement. She tried aspirin, which seemed the only thing to partially relieve the pain. PHYSICAL EXAM - Stance and gait were within normal limits, except for a mildly antalgic gait favoring the right. The foot and ankle were normal to inspection, without any skin changes, swelling, atrophy or efusion. The ankle was non-tender and stable to ligamentous exam. The foot was remarkable only for point tenderness at the distal aspect, proximal phalynx of the great toe. She had a 60 degree arc of motion of the IPJ of the great toe with some increased pain in extreme flexion. Neurovascular testing was intact. Running shoes showed no abnormal wear. RADIOGRAPHS - Circular lytic lesion in the distal aspect of P1 of great toe, sclerotic border and tiny sclerotic center.
DIFFERENTIAL DIAGNOSIS - Neoplasm Osteomyelitis Stress fracture TESTS AND RESULTS - Bone scan - Intense increased uptake in head of P1 great toe. CT Scan - Circular lytic lesion with dense sclerotic border, sclerotic tiny central "bull's eye". DIAGNOSIS - Osteoid osteoma TREATMENT - Surgical resection with cuboid bone graft reconstruction. Biopsy confirmed osteoid osteoma. Protected in post-op shoe for 6 weeks until bone graft incorporation. OUTCOME - Healing with complete relief of pain. Patient returned to running and full activity without ant residual symptoms.
