2002 OITE Question 110

Question

Figure 20 shows the radiograph of a patient who has medial foot pain. What is the best course of action in management of the phalanx lesion?

1. MRI

2. Fourth metatarsophalangeal joint amputation

3. Needle biopsy

4. Observation

5. Open biopsy

Figures

Answer (click for answer)

Preferred Answer: 4

Enchondroma are the most commonly seen benign tumors of the small bones of the foot. It is composed of mature hyline cartilage, which occurs in the medullary cavity of the bone. Enchondroma may present as a solitary lesion, or as multiple lesions as in multiple enchodromatosis (Ollier’s disease). Enchondroma usually present between 1st and 5th decades of life, most commonly presenting during the 2nd and 3rd decades. Enchondroma affecting the small bones of the foot are usually a symptomatic, and are found as an incidental finding on routine x-ray. When enchondromas become symptomatic , the most common cause of pain is an increase in pressure due to the expansion of the lesion with deformity of the cortex of surrounding bone. The treatment of an Enchondroma may range from simple observation and careful follow-up, as in the case of small a symptomatic lesions, to total resection and bone grafting for the larger symptomatic lesions. Pt in the question has an asymtomatic echondroma which is an incidental finding (his complain is medial foot pain and not the toe). As a result the answer is observation.

Reference: Stess RM, Tang RE :Enchondroma of the proximal phalanx. J Foot Ankle Surg 1995;34:79-81