Hallux Osteoid Osteoma: A Case Report and Literature Review

Abstract

Osteoid osteoma is a benign bone tumour that mostly affects males in the second and third decade of their life. The lesion mainly occurs in long bones, usually in the femur and tibia, causing severe localized pain that is worse at night and responds to nonsteroidal anti-inflammatory drugs (NSAIDs). Diagnosis is usually made on the basis of history and radiographic findings. However, in more unusual locations as the hand and foot, diagnostic issues can arise. Treatment often includes complete removal of the tumor. We present a 22 year old male with osteoid osteoma involving the distal phalanx of the hallux. To our knowledge very few cases of great toe osteoid osteoma have been reported in the literature.

Hallux Osteoid Osteoma: A Case Report and Literature Review

“…The infection risk, local vascular conditions, soft tissue envelope/tissue loss, and the involvement of critical local anatomic structures are poles apart. There is merit in en bloc resection and preservation of the residual phalanx (as has been reported by Xarchas and colleagues [1]). Autologous grafting would seem a reasonable option whereby <50% of the phalangeal width remains -the general shape of the phalanx lends itself nicely to a small solid iliac crest graft.…”

“…In summary, the paper of Xarchas and colleagues [1] meaningfully contributes to the very limited clinical pool of understanding regarding management of DP osteoid osteomas -most specifically in the great toe. The work provides a succinct summary of the limited contemporary evidence-base and provides a framework around which to consider management of future patients under similar conditions.…”

“…The recently published work by Xarchas and colleagues [1] describes the uncommon presentation of an osteoid osteoma in the distal phalanx (DP) of the hallux [2]. This well-written work makes a noteworthy contribution to the state-ofcontemporary-understanding both as an individual case summation and as an elegant (albeit brief) review of the available literature.…”

“…Specifically considering osteoid osteomas, given anatomic barriers, the inability to safely offer modern RF ablation to digital extremities steers treating clinicians towards either aggressive (and likely prolonged) symptomatic management or consideration for surgical treatment [4]. Poor tolerance and efficacy limit the former in many instances [1,5]. While amputation can seem an 'easy' option, the loss of a hand digit or (especially) a border digit of the foot can have major functional ramifications [6].…”

Going toe-to-toe with a rare case of a complex regional pain syndrome limited to the hallux

“…A painful condition of the first radius of the foot can be encountered under many clinical conditions: 19 trauma (contusion, sprain and fracture), osteoarthritis (hallux rigidus), rheumatic diseases (microcrystalline arthritis, spondylarthropathy and rheumatoid arthritis), infection (with common germs, but also tuberculosis, which exceptionally can cause dactylitis), 20 osteonecrosis (metatarsal or sesamoid), tumour (metastasis, sarcoma and giant cell tumour or osteoid osteoma). 21 Neuropathy or vascular pathology can also be considered. In our case, all these diagnoses could be ruled out.…”