Module 48, Pediatric Orthopaedist Level

1, 2, 3, 4

At age 12 months a girl presents severe overgrowth of the foot. She was the product of a normal pregnancy and delivery and is otherwise completely healthy. The parents main complaint is that she can not be fitted with shoes. She had an amputation (image 1 & 2) of the 2nd and 3rd toes at the level of the mid diaphysis, proximal phalanx and extensor tendon release of the 2nd and 3rd toes with excision of abnormal fibrofatty tissue of right foot, at age 5 years, she underwent partial amputation of the right 2nd and 3rd metatarsals(images 3 & 4). Now at age 10, she has been doing well, participating in all sports. She has noted that there has been some difficulty in finding shoes that fit, but does not complain of any pain.

Question 48A

Neurofibromatosis must be considered in the differential diagnosis in the above child.

Question 48B

Doing an operative procedure to strip the nerves going to the foot is an option to treat this condition.

Question 48C

The bone age in the large digits appears greater than in normal digits which is common in this condition.

Question 48D

Epiphyseal arrest of the metatarsal bones is another treatment option.

Question 48E

A reasonable treatment option in the above patient would have been a below knee amputation at the first procedure.