Pseudoaneurysm after Proximal Metatarsal Osteotomy for Hallux Valgus Correction: A Case Report

Abstract

Occurrence of pseudoaneurysm in the foot and ankle is rare, and is usually caused by traumatic injury or by iatrogenic intervention. Iatrogenic pseudoaneurysms in the foot and ankle have been observed after rearfoot and ankle fusions, ankle arthroscopy, endoscopic and open plantar fasciotomy, tibial osteotomy with limb lengthening, midfoot amputation, and Lapidus procedure. We report on a patient who developed a pseudoaneurysm of the dorsal metatarsal artery following correction of hallux valgus. The patient underwent proximal chevron osteotomy and Akin phalangeal osteotomy. The feeding artery was ligated and the pseudoaneurysm was excised.Key Words: Hallux valgus, Corrective osteotomy, Pseudoaneurysm otomy. As far as we are aware, no one patient has previously been reported after such procedures. The patients and her families were informed that data from the case would be submitted for publication, and gave their consent. CASE REPORTA 55-year-old woman presented for the evaluation of a mass on the dorsum of the left foot. On examination, there was an approximately 2×2 cm mildly tender pulsatile mass in the dorsal soft tissues of the right midfoot (Fig. 1A). By history, the mass had been present 3 months after hallux valgus correction. She had a proximal chevron osteotomy and Akin osteotomy with Kirschner wires fixation (Fig. 1B). The operation was done without any difficulties and specific problems. She felt bruit on her foot dorsum since 3 days after the operation. Kirschner wires were removed at 6weeks after the operation as usual. Ultrasound of the soft tissue mass was performed, demonstrating an ovoid heterogeneous welldefined vascular mass, measuring 1.3 cm longitudinally by 1.6 cm transversely by 1.2 cm in depth. Echogenic mural thrombus surrounded a central, well-defined, 8-mm diameter anechoic region within the mass that contained swirling vascular signal on a color Doppler ultrasound (Fig. 1C). An adjacent, normal-sized first dor-A pseudoaneurysm rarely occurs in the foot and ankle, and is usually caused by traumatic injury or by iatrogenic intervention. We report a patient in whom pseudoaneurysms of the dorsal metatarsal artery developed following a correction of hallux valgus. The patient had proximal chevron osteotomy and Akin oste-

Pseudoaneurysm of the Second Dorsal Metatarsal Artery: Case Report and Literature Review

“…In our review of the literature, only 1 metatarsal artery pseudoaneurysm has been published as occurring in man, and 1 in a horse. 9 , 10 The equine case was a pseudoaneurysm of a dorsal metatarsal artery that was secondary to trauma, and it spontaneously resolved after diagnosis. The human case was secondary to proximal chevron osteotomy and Akin phalangeal osteotomy, and it occurred at the division of the dorsalis pedis artery into the first metatarsal branch and arcuate artery.…”