A Unique Case of Hereditary Multiple Osteochondromas in the Feet

Abstract

This report describes the differential diagnosis of osseous growths in the first metatarsals of an adult male previously unreported in the literature. Examination of the remains via macroscopic analysis and conventional radiography identified unusual bilateral growths arising from the lateral aspects of the first metatarsals with growth directed towards the tarsometatarsal joint. Two exostoses in the ribs were also observed. Using the available evidence, hereditary multiple osteochondromas (HMO) was determined the likely causative disorder for the pedal growths based on the presence of cartilage caps on the ends of the growths, a lack of articular morphology, and the presence of a rib exostosis consistent with HMO. The potential bilateral expression of HMO in the first metatarsals in this case challenges the dominating diagnostic criteria that HMO growths are directed away from the growth plate and only occur in the metaphysis, expanding the spectrum of HMO’s manifestation in the human skeleton. Medical records for the decedent provided no indication of a disorder associated with the development of osteochondromas, nor any indication that medical treatment was undertaken to manage the growths.