■大足是罕见的非遗传性先天性四肢异常,并且在治疗上存在困境,但是开发了多种治疗方式,但并非对所有大足患者都是统一的。手术治疗的目标是实现足部的无痛和功能。
方法:我们报告了一名14岁的男性,第二,3rd,自出生以来右脚的第四和第五脚趾,与无法穿鞋有关。入院前一个月,他经历了逐渐发作的前足和脚趾疼痛,随着时间的推移,严重程度逐渐增加,与无法正常行走有关。他是第一个出生在一个有四个孩子的家庭,他的其他兄弟姐妹都很健康,没有异常现象。关于临床评估,他身体健康,生命体征稳定,放大了第二个,3rd,右足第4、5趾无压痛,神经血管状态完整。在临床和放射学评估中,他被诊断出患有先天性右脚巨大畸形,包括整形外科医生和假肢团队在内的多学科团队同意进行跨meta骨,然后制作部分足部假肢。他接受了受影响的足部的跨meta截肢术,并采集了组织样本进行组织病理学检查。组织学发现显示骨增大,皮下脂肪组织增殖增加,纤维间隔增加,表皮变薄,特征提示脂肪瘤病。14天后伤口愈合良好,孩子计划在6周后进行随访,术后12周和6个月。在最后一次访问中,他的右前脚和脚趾没有疼痛,能够正常佩戴预制的部分足部假肢和鞋子,走路时没有丧失能力。
结论:我们的病例报告是独特的,因为右脚的多个脚趾累及第三和第四脚趾,其治疗具有挑战性,因为其手术治疗没有统一性,在我们的病例中,患者进行了经跖骨截肢手术,随访6个月后进展良好.
结论:大足畸形是罕见的先天性畸形,最常见的是右脚。不管治疗上的困境如何,我们的患者的经跖骨截肢和人造假体达到了无痛右脚的目标,并且能够穿鞋和正常行走而没有损伤。
UNASSIGNED: Megadactyly of the foot is uncommon non hereditary congenital anomalies of the extremities and poses a dilemma on treatment however multiple treatment modalities were developed but is not uniform to all patients with megadactyly. The goal of the surgical treatment is to achieve painless and function of the foot.
METHODS: We report a 14 years old male presented with complaints of progressive enlargement 2nd, 3rd, 4th and 5th toes of the right foot since birth, associated with inability to wear shoes. One month prior to admission he experienced gradual onset painful forefoot and toes that was increasing in severity with time associated with inability to walk normally. He is the first born in a family of four children and his other siblings are healthy with no anomalies. On clinical evaluation, he was health with stable vitals, with enlarged 2nd, 3rd, 4th and 5th toes of the right foot with no tenderness with intact neurovascular status. On clinical and radiological evaluation he was diagnosed with congenital megadactyly of the right foot, a multidisciplinary team including orthopedic surgeons and prosthetics team agreed to do trans-metatarsal, then partial foot prosthesis fabrication. He underwent trans-metatarsal amputation of the affected foot and tissue sample was taken for histopathology. The histological findings revealed bone enlargement with increased proliferation of subcutaneous adipose tissues with increased fibrous septae together with thinning of the epidermis, features suggestive of lipomatosis. The wound site healed very well after 14 days stitches were removed and the child was scheduled for follow-up after six weeks, 12 weeks and 6 month post-surgery. On the last visit he was free from pain on his right forefoot and toes, able to wear fabricated partial foot prosthesis and shoes normally, walk with no incapacitation.
CONCLUSIONS: Our case report is unique due to the involvement of the multiple toes of the right foot with syndactyly at third and fourth toes and its management is challenging because there is no uniformity in its surgical treatment, in our case trans-metatarsal amputation was done and the patient progressed well after six months of follow up.
CONCLUSIONS: Foot megadactyly is uncommon congenital malformation, most common on the right foot. Regardless of the dilemma on treatment, the trans-metatarsal amputation and a fabricated prosthesis to our patient fulfilled the goals of painless right foot and able to wear shoes and walk normally with no impairment.