Osteochondromas around the ankle: Report of a case and literature review

An Unusual Giant Osteochondroma of Distal Tibia: A Case Report with Literature Review

Introduction

Benign bone tumors like osteochondroma are common during skeletal maturity occurring usually at the ends of long bones, such as the distal femur, proximal humerus, and proximal tibia. The tumor can occur in sessile or pedunculated forms. Mass lesions occurring around the ankle can lead to chronic pain, pathological fractures, progressive erosion, and scalloping of adjacent bone. This report highlights a case of a progressively enlarging bony swelling around the distal tibia with uncommon radiological and histological presentation managed with en bloc excision.

Case Report

A 30-year-old male with 3 years of progressive bony enlargement without any history of significant trauma presented to our tertiary care hospital. The radiological and histological investigations were performed and many varied differentials were proposed. The lesion was provisionally diagnosed to be a case of an uncommon form of osteochondroma and en bloc excision was done. The patient followed up for a period of 6 months and the patient had uneventful recovery with no recurrence.

Conclusion

Osteochondromas in the distal tibia are infrequent occurrences among common skeletal tumors. Timely surgical intervention is recommended for symptomatic lesions or those causing compression or mass effects.

Excision of a Distal Tibial Interosseous Osteochondroma Through Posterolateral Approach: A Case Report

Osteochondromas arising from the interosseous border of the distal tibia are rare, but cases have been reported previously in the literature. In long-standing cases, they can cause a "mass effect" resulting in the deformation of the bones around the ankle joint, mechanical restriction of joint movement, and even degenerative joint disease. Hence, they need to be resected if patients present with such impending complications. Several surgical techniques have been described previously for tumor resection including the anterior approach and the trans-fibular approach, the latter of which required a fibular osteotomy with or without fibular reconstruction. The surgical technique described here utilizes the posterolateral approach to the ankle joint for tumor excision, thus avoiding the need for any osteotomy or fibular reconstruction and reducing the risk of injury to major neurovascular structures. It also reduces the need for long-term immobilization and promotes a faster return to activity.

Management of Distal Tibial Interosseous Osteochondroma: A Case Series and Review of Literature

The interosseous part of the distal tibia is one of the regions in which osteochondroma can occur. Osteochondroma typically occurs among growing children and causes gradual ankle deformity by its pressure effect on the fibula. We presented six patients (Five boys and one girl with median age of 13 years old) with distal tibial interosseous osteochondroma. They were treated by a 180̊ fibular osteotomy around its longitudinal axis just proximal and distal to the lesion. All patients were treated without any complication except for one who developed non-union of the site of the fibular osteotomy. In the last follow-up, all the patients were pain-free, and no recurrence was reported. Various methods have been described for resecting interosseous osteochondroma of the distal tibia, with or without fibular osteotomy and with or without acute correction of ankle deformity during resection surgery. Still, there is no consensus over the best method for resecting such lesions.

Achilles Rupture in the Setting Posterior Tibial Osteochondroma: A Case Report and Guidelines for Management of Osteochondromas Adjacent to Tendons

Introduction

The presentation of the included patient is unique, and the thought process regarding management algorithms used to manage this patient is important to discuss so that other surgeons may benefit. This is the first report of its kind, to our knowledge.

Case Report

A 30-year-old healthy Caucasian male presented with acute Achilles tendon rupture after feeling a pop while playing basketball, in the setting of a known posterior tibial osteochondroma and a recent increase in physical activity.

Conclusion

The resultant injury is likely due to mechanical irritation at the tendon site, which caused wear over time and eventual acute rupture. We expanded our percutaneous repair to include an evaluation of the posterior compartment to adequately visualize and excise the large bony lesion. Therefore, we conclude that it is reasonable to counsel patients with known osteochondromas in this location due to the risk of possible Achilles injury, particularly if at all symptomatic.

A Rare Case of Exostosis of the Medial Sesamoid Bone

Introduction

Exostoses in the foot and ankle are extremely rare with no current literature of exostosis of the sesamoid bone.

Case Report

A middle-aged woman was referred to orthopedic foot surgeons following a long-standing issue of a painful non-fluctuant swelling beneath her left hallux with normal imaging. Repeat X-rays, with sesamoid views of the foot, were conducted due to the patient's ongoing symptoms. The patient underwent a surgical excision and made a complete recovery. The patient is now able to comfortably walk for longer distances with no restrictions to her mobility.

Conclusion

Conservative management should be initially trialed to preserve the foot's functions and limit the risk of surgical complications. As in this case, when surgical options are explored, it is critical to preserve as much of the sesamoid bone as possible to restore and sustain function.

Osteochondroma of talus: A case report from Nepal

Osteochondroma, the most frequent benign bone tumor, develops in the metaphysis of long bones including the proximal humerus, tibia, and distal femur. The involvement of talus is found only in a few patients. Here, we present a case of osteochondroma of the talus in a 52‐year‐old woman who presented with ankle pain and edema.

Talus may be affected in the osteochondromas. Surgical excision is a successful technique of treatment for symptomatic osteochondromas with low recurrence, despite the fact that most osteochondromas are treated conservatively.

Rare Osteochondroma of the Posterior Talar Process: A Case Report

Osteochondromas are benign bone tumors that arise from divergent cartilage formation, most commonly in childhood versus adulthood. We report the case of a healthy 42-year-old woman who presented with an unusual solitary posterolateral ankle mass with associated pain and ankle impingement with 6-week follow-up. The patient was successfully treated with open surgical excision, with bone sent for pathologic diagnosis of benign osteochondroma. The patient returned to normal baseline function with no pain at 6-week follow-up. An open posterior ankle incision approach was performed to remove suspicious enlarged bony growth from the posterior talar process to be sent for pathologic evaluation. Pathologic evaluation reported benign osteochondroma of the posterior talar process, and the patient subsequently had routine healing of the postoperative incision site and return to full function without pain or disability at 6-week follow-up. This case study adds to the current understanding, incidence, occurrence, and treatment of rare osteochondromas occurring in the posterior talar process.

Tarsal tunnel syndrome secondary to osteochondroma of the calcaneus: a case report

Background

Tarsal tunnel syndrome is an entrapment neuropathy that can be provoked by either intrinsic or extrinsic factors that compresses the posterior tibial nerve beneath the flexor retinaculum. Osteochondroma, the most common benign bone tumor, seldom occur in foot or ankle. This is a rare case of tarsal tunnel syndrome secondary to osteochondroma of the sustentaculum tali successfully treated with open surgical excision.

Case presentation

A 15-year-old male presented with the main complaint of burning pain and paresthesia on the medial plantar aspect of the forefoot to the middle foot region. Hard mass-like lesion was palpated on the posteroinferior aspect of the medial malleolus. On the radiological examination, 2.5 × 1 cm sized bony protuberance was found below the sustentaculum tali. Surgical decompression of the posterior tibial nerve was performed by complete excision of the bony mass connected to the sustentaculum tali. The excised mass was diagnosed to be osteochondroma on the histologic examination. After surgery, the pain was relieved immediately and hypoesthesia disappeared 3 months postoperatively. Physical examination and radiographic examination at 2-year follow up revealed that tarsal tunnel was completely decompressed without any evidence of complication or recurrence.

Conclusions

As for tarsal tunnel syndrome secondary to the identifiable space occupying structure with a distinct neurologic symptom, we suggest complete surgical excision of the causative structure in an effort to effectively relieve symptoms and prevent recurrence.

A Revised Surgical Strategy for the Distal Tibiofibular Interosseous Osteochondroma

Osteochondroma is one of the most common benign bone tumor; however, the surgical treatment still remains a challenge for those that occur at the distal tibiofibular interosseous location. Previously, the transfibular approach has been successfully described, but the potential damage of the syndesmosis would give rise to the instability of the ankle joint and thus may result in the unfavorable long-term outcome. Here, a revised strategy which can protect the syndesmotic complex is introduced. From 2010 to 2017, eleven patients with the distal tibiofibular interosseous osteochondroma who underwent the revised surgery were collected. The distal fibular osteotomy and posterior tibial osteotomy were performed to keep the inferior syndesmosis intact for better stability of the ankle joint. Both the anterior tibiofibular ligaments (AITFL) and posterior tibiofibular ligaments (PITFL) have been preserved successfully, and thus, the stability of the ankle joint has been maintained due to our strategy. The VAS and AOFAS scores were utilized to assess the clinical outcome and function. Postoperatively, all the patients were pain-free and were able to wear the appropriate shoes at the last follow-up. Preoperative and postoperative AOFAS scores were 93.63 ± 6.91 and 47.27 ± 5.27 (P < 0.05), respectively. Moreover, the average VAS score was 1.73 ± 0.27 (compared with preoperative as 7.45 ± 2.15, P < 0.05), demonstrating obvious improvement after the operation. To our best knowledge, this is the first time to perform the resection of the distal tibial interosseous osteochondroma involving the fibula without interrupting the inferior syndesmotic complex especially the AITFL and PITFL. We believe that this strategy may pave a new way for optimized clinical outcome for these patients with distal tibiofibular interosseous osteochondroma. This clinical trial study is registered with number ChiCTR1900024690.

[Foot and ankle tumours : Part I: overview of incidence, diagnosis and staging of pedal tumours]

CLINICAL ISSUE

Foot and ankle tumours are rare. Part I of this paper provides a survey about tumour distribution regarding age and location of benign and malignant bone and soft tissue tumours.

STANDARD RADIOLOGICAL METHODS

All diagnostic radiological procedures are used for the diagnostic work-up of pedal tumours, in particular plain radiography, MRI, and ultrasonography.

METHODICAL INNOVATIONS

Dual-energy CT proves to be a valuable (differential) diagnostic tool in identifying urate dihydrate crystals.

PERFORMANCE

There are no reliable numbers available on accuracy of the aforementioned diagnostic procedures regarding tumour detection and identification. This is particularly true for soft tissue tumours which are small and well-defined, thus requiring histological clarification.

ACHIEVEMENTS

To evaluate pedal tumours correctly and reasonably, a full range of radiological diagnostics should be employed. Neither plain radiography alone nor a stand-alone MRI examination-depending on the tumour site-are sufficient to characterize such tumours including staging.

PRACTICAL RECOMMENDATIONS

Plain radiography remains the first-choice imaging modality. Ultrasonography is superior to reliably detect and identify ganglion cysts. MRI, however, continues to remain the upmost diagnostic modality of choice for evaluating foot and ankle tumours. CT possesses unchallanged diagnostic power to assess osseous changes. Bone scintigraphy (including SPECT-CT) and FDG-PET imaging are used when multifocal distribution or metastatic disease are suspected or to detect avidity of the pedal lesions, respectively.

Distal Fibular Osteochondroma Resulting in Tarsal Tunnel Syndrome: Case Report and Literature Review

BACKGROUND

Osteochondromas are benign osseous tumors encountered most routinely by physicians responsible for diagnosing musculoskeletal disorders. Often, these osseous lesions are identified following symptoms related to their impingement on adjacent soft tissue or bone.

METHODS

This article presents a unique case of an asymptomatic osteochondroma of the distal fibula in a 29-year-old Caucasian woman that manifested clinically as an impingement on the tibial nerve.

RESULTS

After resection of the osteochondroma, the patient's tarsal tunnel syndrome symptoms resolved.

CONCLUSIONS

This case report demonstrates a never-before-described osteochondroma of the distal fibula traversing posterior to the ankle joint and impinging on the tibial nerve. After resection, the patient's symptoms resolved.

A Rare Case of Tibioperoneal Arterial Trunk Entrapment Caused by a Fibular Osteochondroma

BACKGROUND

Osteochondromas or exostoses are the most common benign tumors of the bones, which appear during the growth period. The involvement of lower extremities is common, particularly in metaphyseal structures of the femur and humerus and around the knee joint. However, the incidence of the development of the tumor at the proximal fibula is rare. The most common signs and symptoms of the disease are pain, pulsatile mass, limb swelling, neurologic sequelae, bursa formation with subsequent bursitis, and impairment of the developmental growth. Vascular complications are rare, yet osteochondromas can cause catastrophic arterial complications threatening the life of the patient if they occur and can include vessel perforation and thrombosis, arterial thromboembolic events, and pseudoaneurysm formation.

METHODS

We report a case of a 24-year-old male patient presenting with tibioperoneal arterial trunk entrapment caused by a massive osteochondroma derived from the proximal fibula. A combined vascular-orthopedic approach was initiated with the excision of the tumor, in which the neurovascular structures (tibial nerve, popliteal artery and vein, anterior tibial artery, and tibioperoneal trunk) were carefully recognized and protected.

RESULTS

The postoperative course of the patient was uneventful.

CONCLUSIONS

High clinical suspicion of a vascular complication should be raised by physicians when investigating a young patient with a suspected osseous tumor in the popliteal fossa and symptomatology of concurrent peripheral arterial disease. Prompt surgical management is crucial for the salvage of the affected limb in cases of arterial involvement. Furthermore, quick surgical exposure of the mass and regular postoperative follow-up check minimizes the risk of irreparable impairments and tumor recurrence.

Bilateral arthrodesis of the distal tibiofibular joint for deforming osteochondromatas

The first case of bilateral distal tibiofibular joint fusions for osteochondromas is reported with excellent long-term outcomes.

Extensive Osteochondroma of Talus Presenting as Tarsal Tunnel Syndrome: Report of a case and Literature Review

Osteochondroma or exostosis is the most common benign bone tumor, and occurring frequently in the proximal humerus, tibia, and distal femur. It rarely affects talus. Osteochondroma of talus is a very rare etiology of tarsal tunnel syndrome (TTS). We report a rare case of extensive osteochondroma of the talus in a 60 year old female presenting with multiple swellings around the ankle and symptoms suggestive of tarsal tunnel syndrome. En-block excision of the multiple masses was done. Histopathological examination confirmed the diagnosis of osteochondroma. Although most of the osteochondromas are being treated conservatively, those presenting with multiple swellings, restriction of movements and compressive neuropathies should be treated with surgical excision. Excision is a successful method of treatment for symptomatic osteochondromas with low recurrence.

Femoral exostosis causing vastus medialis pain in an active young lady: a case report

BACKGROUND

Musculoskeletal conditions are a common reason for consultation to General Practitioners (GPs)/family physicians in primary care. Osteochondromas are the most common benign bone tumours and usually occur in the metaphyseal region of long bones. Despite the distal femur being the commonest location to find these benign bone tumours, this is the first case report in the literature specifically describing vastus medialis muscle pain as the presenting symptom due to underlying bursa formation secondary to local pressure effects.

CASE PRESENTATION

Twenty nine year old female of white British ethnic origin, presenting to a primary care clinic with a three year history of intermittent left distal medial thigh pain.

CONCLUSION

The benign bone tumour, femoral exostosis/osteochondroma, was diagnosed via Magnaetic Resonance Imaging (MRI) and treated conservatively, with surgical excision an option if not resolving. GPs/family physicians need to be aware of this diagnosis and that femoral exostosis/osteochondroma can present to primary care physicians, particularly within the second decade of life.

Multiple osteocartilaginous exostoses of the lower extremity: a case report

An osteochrondoma is a benign osseous tumor capped by cartilage. Osteochondromas occurring at the distal tibia and fibula are uncommon and even more so when occurring at the first metatarsal head. Osteochondromas usually occur at the metaphysis of long bones; however, they can occur at other cortical bone metaphyses. This is a case report of a 54-year-old male with incidental radiographic findings of multiple osteochondromas around his ankles as well as a solitary osteochondromatous lesion growing proximally off the left first metatarsal head. The multiple osteochrondomas were evident on multiple views, and subsequent histological analysis of the solitary osteochondromatous lesion via total surgical excision confirmed a diagnosis of multiple hereditary osteochrondromatosis.

Osteochondroma of the Talar Neck: A Case Report and Literature Review

Osteochondroma occurs most frequently in the long bones such as the proximal humerus, tibia, and distal femur. It is rare for it to originate in the talar neck. In the present case report, we describe a case of osteochondroma arising from the talar neck. Furthermore, a review of the published studies of talar osteochondroma was performed to obtain a better understanding of the symptoms, diagnosis, and treatment of this unusual entity.