Multiple abnormalities in the feet and associated changes elsewhere in the skeleton: The case of 3A-7 from a Capsian Site in Algeria.

A skeleton with a number of abnormalities is described involving full discussion of alternative diagnoses. In this complex case, the primary diagnosis is of avulsion of the stem of the bifurcate ligament causing a fracture of the anterior process of the calcaneus. The bilateral fracture identified in Skeleton 3A-7 from Site 12, a Capsian site in Algeria, is a result of the feet being inverted and plantar flexed: the fracture is prone to non-union, which is asymmetrical here. There is also a separate anatomical variation of the feet, 3rd cuneiform and 3rd metatarsal coalition, which was not the cause of trauma. The bifurcate ligament is a major stabilizer of the lateral transverse talar joint, and the trauma could lead to further issues: however, multiple other traumatic changes in 3A-7 most likely occurred at the same time, rather than as the result of pre-existing foot trauma. The asymmetry of the calcaneal condition and asymmetry of the sequelae of the original trauma led to long bone asymmetry, the result of locomotor difficulties.

Foot polydactyly and bipartite medial cuneiform: A case of co-occurrence in a Celtic skeleton from Verona (Italy).

We report a case of bilateral foot polydactyly and bipartite medial cuneiform in a male individual buried in a Celtic/Roman necropolis (3rd to 1st century BCE) in the city of Verona (Italy). During the construction of an underground garage in the main courtyard of the Bishop's Seminary at Verona between 2005 and 2010, archaeologists uncovered the remains of 174 individuals (108 non-adults and 66 adults). It is thought that these graves could belong to some of the first inhabitants of the urban area of Verona. The individual presented here (US 2807) is a middle-aged male (40-50 years) in a good state of preservation. His estimated stature is 1756 mm (± 32.1 mm). This male presents congenital anomalies in the feet and dental agenesis. We believe this to be the only known archaeological case of bilateral postaxial polydactyly with forked (Y) shape, in which both fifth metatarsals are associated with complete bipartition of the left medial cuneiform and partial bipartition of the right one. Polydactyly is fairly common in modern clinical cases but bipartite medial cuneiform is relatively rare; neither of these congenital conditions is well documented archaeologically.

[Historical review of congenital foot deformity treatment].

INTRODUCTION: There is still no good solution for the treatment of all the forms of clubfoot. HISTORY OF THE TREATMENT IN THE WORLD: The first written description of the treatment of this deformity was given by Hippocrates. In the Middle Ages, Galenus, Celsus and Averroe only reviewed the lessons of Hippocrates's principles. The first description of orthopedic prosthetic for the treatment of clubfoot was published in "Opera Chirurgica" by Amboise Peréa in 1575. In 1796, Bruckner wrote the first monography about clubfoot. The biggest contribution to the modern way of treating clubfoot was given by Abel Mix Phelebs, who described the medial "release" in 1890. Since 1980 an advantage has been given to early non-operative treatment. The progressive operative approach (use of "release procedures") was introduced. THE HISTORY OF TREATMENT IN OUR COUNTRY: The first procedures were performed by D. Jovcic and S. Stojanovic in Belgrade in 1937. In the period from 1960 to 1970, more and more orthopedic and pediatric surgeons became interested in clubfoot treatment. In 1970 one of the main topics of the 5th Congress of Orthopedics and Traumatology in Belgrade was "Foot Surgery". Many specialists from Belgrade were engaged in clubfoot treatment: D. Rakic, S. Rajic, S. Popovic, L. Stojanovic among pediatricians, and B. Radulovic, P. Klisic among orthopedic surgeons, as well as R. Brdar, Z. Vukasinovic and G. Cobeljic with their assistants. In Novi Sad, in 1967, D. Pajic began diagnosis and treatment of clubfoot. Very soon D. Pajic became a symbol of clubfoot treatment followed by hardworking assistants L. Petkovic and V. Tomasevic. CONCLUSION: The treatment of clubfoot is still controversial and continues to be one of the most interesting fields in pediatric orthopedics.

Bipartite medial cuneiform: new frequencies from skeletal collections and a meta-analysis of previous cases.

Bipartition of the medial cuneiform is a malsegmentation defect of the foot characterized by separation of the normal cuneiform into dorsal and plantar segments. In many cases, these segments are held together by means of a cartilaginous or fibrocartilaginous bridge, resulting in a deep, lytic-like pit in dry bone reminiscent of those seen in cases of non-osseous tarsal coalition. Partial bipartition, where separation of the two segments is incomplete, may also occur. Though originally documented over 250 years ago, relatively little is known about the bipartite medial cuneiform. The purpose of this paper is to present thirteen new cases (ten complete, three partial) from Egypt, England, South Africa, Denmark, and the United States, and to analyze all known cases to investigate patterns in sex, laterality, frequency, and associated anomalies. Results suggest that bipartite medial cuneiforms are significantly more prevalent in males. Bipartite medial cuneiforms are also frequently bilateral, perhaps indicating a strong genetic component. Identification of this condition in multiple individuals from a cemetery could, therefore, suggest a familial relationship. Frequencies of this variant are consistently less than 1% in most large samples, and significant frequency differences among samples from around the world are rare. Several other minor congenital variations have been noted in individuals with bipartition of the medial cuneiform. However, additional systematic research is needed to elucidate further the prevalence of associated variants.

Hermann Friedberg's case report: an early description of CLOVES syndrome.

CLOVES syndrome is a recently described overgrowth disorder with complex vascular anomalies. Careful analysis of the case report by the German physician Hermann Friedberg "gigantism of the right lower limb" published in 1867 revealed that the report probably represents one of the first written accounts of CLOVES syndrome.

Earliest evidence for arthrogryposis multiplex congenita or Larsen syndrome?

A sixteenth-century illustrated pamphlet from Great Britain suggests that documentary evidence may permit accurate diagnosis of pathological conditions in earlier societies. The document is of particular importance, since the presented congenital abnormalities, including cleft lip, spina bifida cystica, genu recurvatum, and talipes deformity are reported rarely in archaeological skeletal material. It is suggested that the combination of abnormalities may represent the earliest case of arthrogryposis multiplex congenita or Larsen syndrome.

Unilateral ectrodactyly, metatarsal synostosis, and hypoplasia in an Eskimo.

A unilateral foot deformity in an archaeological specimen from Point Hope, Alaska, is presented. Radiographic and gross examination of the bones of the malformed left foot suggests that this adult female suffered from a rare and possibly unique limb deficiency presenting as unilateral congenital absence of the phalanges, synostosis and hypoplasia of the metatarsals, and mild hypoplasia of the calcaneus.

Brachydactyly, a possible inherited anomaly at prehistoric Prince Rupert Harbour.

Disproportionately short metacarpals or metatarsals in eight burial skeletons and three unusually short metapodials recovered as disturbed bones were identified in a 1500 B.C. to A.D. 500 skeletal series from eight archeological sites of the north mainland coast of British Columbia, Canada. At least ten people were affected from four sites for a minimum series frequency of 5.2%. Various factors clinically implicated in the occurrence of brachymetapody were investigated to account for the anomaly. Context-sensitive information suggested that trauma, infarction or infection, and individual or family-related malformation syndromes were unlikely possibilities. Some modern population data suggest that the series frequency was unusually high, particularly for fourth metatarsal involvement, the most commonly affected bone. Modern pedigree interpretations, ethnohistoric inferences, and the archeological contexts of the affected burial skeletons and site samples provide a framework for concluding that brachymetapody in the series was more likely due to the inheritance of an essentially isolated anomaly.