Particulate synovitis granuloma complication following a first metatarsophalangeal joint silastic implant.

This case presents a known complication of particulate synovitis granuloma associated with a first metatarsophalangeal joint silastic implant. However, the degree of soft tissue granuloma enlargement is quite unique in size and its proliferative effect-invading the medulla cavity and infiltrating the outer cortex of bone. This case study aims to demonstrate its clinical presentation, imaging investigations, surgical excision and histopathology findings. The learning points emphasised within this manuscript draw attention to the procedure selection for a silastic implant, as well as its proposed mode of action and various potential associated complications. Surgery was based on careful analysis of overall function, prior surgery conducted and patient expectations to achieve a shared decision-making process.

A case report. Tenosynovial giant cell tumour in the tendon of extensor digitorium longus.

Soft tissue lesions found within the foot and ankle can vary in their origin. Tenosynovial giant-cell tumours (TSGCT) are quoted as rare in their presentation yet also reported to be the sixth most common benign lesion in the foot. This article presents a case report following the patient journey suffering with a TSGCT of the fourth toe. From initial consultation, to further investigation with advanced imaging to a final decision on surgical excision following consideration of conservative management.

Guided Intra-articular Corticosteroid Injections in the Midfoot.

BACKGROUND: Intra-articular corticosteroid injections are used for both their therapeutic and diagnostic function. There is a paucity of literature investigating the efficacy of intra-articular corticosteroid injections into the midfoot. The aim of the study was to identify the efficacy of image guided intra-articular corticosteroid (Methylprednisolone) injections for midfoot osteoarthritis The null hypothesis of this study was there would be no benefit or increase of the Self-reported Foot and Ankle Score (SEFAS) from an intra-articular corticosteroid injection. METHODS: SEFAS was collected at 4 and 12 months postinjection. A total of 37 consecutive patients who had 67 midfoot injections were recruited into the study over a 6-month period. RESULTS: The mean SEFAS score preinjection was 17.0, at 4 months postinjection was 31.8 ( P < .001), and 12 months postinjection 21.3 ( P < .14). There was a statistically significant improvement in postinjection SEFAS ( P < .001) at 4 months. The null hypothesis of this study was rejected. Response to the injection was varied but patients with BMI less than 30 had a sustained ( P < .04) symptomatic improvement at 12 months when compared to the obese patients. CONCLUSION: Our findings support the use of corticosteroid injections as a viable diagnostic and therapeutic option following failed conservative treatment options prior to operative intervention. The results at 4 months were statistically significant with an additional finding of a difference observed between obese and nonobese patients. This may have implications for further educating the patient in effective weight loss that may improve symptom relief from intra-articular injection. LEVEL OF CLINICAL EVIDENCE: Level III, comparative study.