No abstract

No abstract

Nail pathologies have a broad range of origin and may sometimes be complicated in presentation or clinical course, specifically when the pathology remains recalcitrant after treatment. In this case report we discuss a pathologic disorder that was initially misdiagnosed as a pyogenic granuloma surrounding an ingrown nail but was later found to be a benign neoplastic bone growth, Dupuytren exostosis, also known as a subungual exostosis. Operative treatment was deemed appropriate for the patient, and the exostosis was resected, leaving a soft-tissue void at the distal toe. The remaining void was filled with a perinatal graft, the use of which has been deemed effective anecdotally in both chronic and acute lower-extremity wounds but has not been widely discussed in the lower-extremity literature. This graft was placed to aid in wound healing over a potentially difficult wound bed. As amniotic, chorionic, and umbilical grafts become more prevalent in lower-extremity surgery, its antitumor effects should be further explored and published. This is the first case report, to our knowledge, of the successful use of a perinatal graft in the setting of a bone tumor, and it demonstrates that certain benign neoplasms can be treated with resection and placement of a perinatal graft while helping to prevent chronic wounds at surgical sites.

DESCRIPTIONA 53-year-old African-American man presented to a local podiatry outpatient clinic with a chief symptom of unilateral pain in the first metatarsophalangeal joint (MTPJ) of his left foot as well as a secondary concern of chronic low back (lumbosacral) pain. He stated that the onset of the foot pain several years ago was insidious, but has been gradually increasing in intensity. He stated that the foot pain was proportionate to the amount and speed of ambulation, and was decreased with non-weightbearing. He also related that he noticed that the foot pain was also somewhat lessened if he 'slowed down', and took shorter steps. He stated that he had tried several types of corrective foot orthotic devices, both over the counter and custom made, none of which provided any significant relief. With regard to his back pain, the patient reported that he was told by his chiropractic physician that he had 'arthritis' at the L4-L5 disc level. The patient stated that his back pain also was not the result of any precipitating trauma, but rather seemed to have increased over the years. He denied any sciatic radiation of pain. While surgery was offered as an option for his foot pain, the patient declined and was seeking any possible non-surgical options.Figure 1 Dorsoplantar radiograph of the left foot: arrow reveals degenerative changes at the first metatarsophalangeal joint.Video 1 Baseline in-shoe pressure and timing analysis (F-Scan) revealed a planus foot, with a complete arthrodesis of the left first MTPJ. In-Shoe pressure and timing analysis with the patient wearing rocking-soled shoes reveals markedly increased active propulsion on the left.Video 2 Video gait analysis with the patient barefoot reveals a decreased step length on toe-off of the left foot when compared with toe-off of the right. There is decreased time in the propulsive phase of gait, a decreased stride length, and a decreased dorsiflexory range of motion at the left MTPJ.

No abstract