Idiopathic Equinocavovarus Foot Deformity in an 8-year-old Girl

Abstract

An 8-year-old girl presented to our clinic with a left foot deformity. According to the parents, the girl's foot was normal in appearance until they noticed a prominence on the dorsal aspect of her foot while trying on shoes approximately 1 year previously. The patient also had progressive difficulty with walking owing to frequent inversion injuries, and problems with shoe wear attributable to the development of dorsal foot callosities. Her only other medical history was vesicoureteral reflux, for which she underwent surgery when she was 8 years old.Her physical examination revealed a normal-appearing right foot but an equinocavovarus deformity of the left foot ( Fig. 1). Coleman block testing was normal, indicating a flexible hindfoot deformity. There was no clawing of the toes or intrinsic atrophy. There was a 1.5-cm decrease in left calf circumference measured 15 cm above the medial malleolus compared with the right. Her neurologic examination showed normal patellar tendon and Achilles tendon reflexes, full strength (5/5) of the posterior tibia, anterior tibia, and triceps surae musculature, and normal sensation. No skin stigmata or spinal asymmetry or deformity were observed.We obtained radiographs (Fig. 2) and MR images (Fig. 3) of the foot; MR images of the brain and spine; radiographs (Fig. 4), CT scans (Fig. 5), and MR images (Fig. 6) of the pelvis; and a whole-body bone scan.Based on the history, physical examination, and imaging studies, what is the differential diagnosis? Imaging InterpretationRadiographs of the left foot showed an equinocavovarus deformity and a mixed lytic and sclerotic lesion with dense lobular areas of calcification (Fig. 2). MRI revealed a multifocal stellate lesion in the calcaneus, which was low signal on T1-weighted (Fig. 3A) and T2-weighted (Fig. 3B) images and did not enhance with gadolinium (Fig. 3C). MR images of the brain and spine were normal.The whole-body bone scan showed mild radiopharmaceutical uptake in the left ischium, left proximal femur, and left calcaneus. No other foci of abnormal uptake were evident.Radiographs of the pelvis showed an area of sclerosis in the left ischium, and intrapelvic densities attributable to Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution has approved the reporting of this case report, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Cross‐Sectional Imaging Useful in Melorheostosis

“…However, it has become increasingly evident that there are, more often than not, surrounding soft tissue abnormalities associated with the disease. (10,(45)(46)(47)(48)(49) These soft tissue abnormalities include fibrous changes, ossification, edema, cysts, vascular malformations, and rarely, malignant tumors. (10,32,48) The extent of soft tissue involvement varies widely between cases, with some patients with debilitating soft tissue masses, while some are spared from any apparent soft tissue involvement.…”