Srinivasalu Santhanagopal, Rajendra Thakre Kunwar
Department of Orthopaedics, St. John's Medical College, Bengaluru, Karnataka, India.
J Orthop Case Rep. 2018 Mar-Apr;8(2):47-50. doi: 10.13107/jocr.2250-0685.1044.
The swellings of foot are common but the lesions of metatarsals are rare. The purpose is to highlight these four cases which had almost common presentations but had different etiologies.
A series of four cases all of which had similar presentation, but different etiologies. One case had foreign body (FB) granuloma, one had tibialis anterior (TA) tendinosis and the other two cases had osteomyelitis, one pyogenic and the other tubercular. All cases underwent curettage and removal of the pathogenic foci, and were diagnosed with tissue biopsies.
Clinical signs in tuberculous (TB) osteomyelitis, pyogenic osteomyelitis, FB granuloma, and tendinosis are generally subtle and lead in most cases to a late diagnosis. In developing countries, where most of the people walk barefoot, FB granuloma due to thorn prick should always be considered as a differential diagnosis. Although rare to find tendinosis of TA, TB osteomyelitis, pyogenic osteomyelitis, and FB granuloma of metatarsals, these conditions should always be considered as differential diagnosis along with tumors.
足部肿胀很常见,但跖骨病变很少见。目的是强调这四例表现几乎相同但病因不同的病例。
一系列四例病例,表现相似但病因不同。一例为异物(FB)肉芽肿,一例为胫骨前肌(TA)肌腱病,另外两例为骨髓炎,一例为化脓性,另一例为结核性。所有病例均接受了刮除术并清除了病灶,并通过组织活检进行诊断。
结核性骨髓炎、化脓性骨髓炎、FB肉芽肿和肌腱病的临床体征通常不明显,大多数情况下会导致诊断延迟。在大多数人赤脚行走的发展中国家,应始终将因荆棘刺伤引起的FB肉芽肿视为鉴别诊断。虽然TA肌腱病、跖骨结核性骨髓炎、化脓性骨髓炎和FB肉芽肿很少见,但这些情况应始终与肿瘤一起作为鉴别诊断。