Morphologic and radiographic characterization of fibular dimelia

Long term follow-up and development of foot complaints in a surgically treated mirror foot-A case report and review of literature

BACKGROUND

Mirror foot is a rare anomaly and limited long term follow-up information is available.

METHODS

Seven years after operation a mirror foot patient returned with foot complaints and was evaluated using radiographs and clinical examination. A systematic literature search was conducted to study foot complaints in mirror feet.

RESULTS

Different origins of foot pain were considered in our patient; tibia length difference, deformed talus and accessory osseous structures in the tarsal region. Literature search resulted in 118 mirror feet. Based on cases reporting osseous structures, 74.2% showed tibia abnormalities and 94.5% an abnormal tarsal region. Only three cases mentioned a normal talus. Nine cases reported a follow-up period of more than five years.

CONCLUSION

Osseous abnormalities are not always visible at birth, but are often present. Therefore, detailed examination of the affected limb in mirror foot patients with foot pain is important, in order to localize the origin.

Mirror foot: treatment of three cases and review of the literature

PURPOSE

To describe three cases of mirror foot and to develop a new classification of the mirror feet with an emphasis on their treatment.

METHODS

Surgical treatment was performed on three patients with mirror foot. Mirror feet in the English literature were surveyed and cases found in PubMed as well as our three cases were classified according to a new classification that was an analogy of the mirror hand classification proposed by Al-Qattan et al. (J Hand Surg Br 23:534-536, 1998).

RESULTS

All three cases obtained satisfactory outcome after the treatment. In addition to these cases, 28 mirror feet were well described in the English literature, among which only seven cases have been documented for their treatment. All of the cases could be assigned to one of the categories of the proposed classification.

CONCLUSION

Mirror foot is a very rare congenital deformity of the foot. We successfully treated three novel cases of mirror feet. A classification of the mirror feet proposed in this article was useful in order to understand its nature and obtain a guideline for its treatment.

Congenital duplication of lower extremity--a case report and review of the literature

Congenital duplication of the lower extremity is quite rare. Only 26 cases have been reported so far. A female infant with incomplete duplication of lower limb and with hypothyroidism was reported. Her mother's pregnancy and delivery was uneventful. A tube-like skin tissue was found on the posterior aspect of the infant's left thigh. Her left foot presented equinovarus deformity. There were three extra toes on the plantar side of her foot. A band of skin with a thin horny layer, similar to the dorsal surface, could be seen on the sole. The skin tube on the thigh was simply resected. A neuro-vascular-islanded toe was made from the plantar toes and rotated to restore five toes on the foot. The transferred toe thrived in accordance with the surrounding toes. The patient could run without difficulty at the age of 3. Previous reports about this case are summarised and reviewed here.

Pre-axial mirror polydactyly associated with tibial deficiency: a study of the patterns of skeletal anomalies of the foot and leg

PURPOSE

The study was undertaken to identify the patterns and spectrum of aberrant development of the skeletal elements of the leg and foot in children with pre-axial mirror polydactyly of the foot.

METHODS

Case records and radiographs of eight children (ten feet) with pre-axial mirror polydactyly were studied. Four feet were seen in association with fibular dimelia, three feet with dysplastic trapezoid shaped tibia, two with tibial aplasia and one with tibial hypoplasia.

RESULTS

Distinct patterns of anomalies of the hindfoot, midfoot and forefoot were noted, with different patterns of leg malformation. Fibular dimelia was associated with duplication of the calcaneum, cuboid and the lateral cuneiform. Talar duplication occurred in children with a trapezoidal tibia. No duplication of tarsal bones was seen in association with tibial aplasia or hypoplasia. The first metatarsal was hypoplastic wherever the tibia failed to develop. Mere resection of the supernumerary rays resulted in a near normal looking foot in feet without calcaneal duplication. The cosmetic appearance of the foot was poorest in children with fibular dimelia.