Symptomatic coalition between the first and second metatarsals in a child

Area of Science:

• Orthopedics
• Podiatry
• Medical Case Reports

Background:

• Foot coalitions are uncommon, affecting about 1% of the population, with talocalcaneal and calcaneonavicular types being most frequent.
• Forefoot coalitions are exceptionally rare, with limited documentation in medical literature.

Observation:

• A 12-year-old girl experienced chronic medial forefoot pain and shoe-wear difficulties due to a unilateral, symptomatic coalition between the first and second metatarsals.
• Physical examination revealed a fixed, rigid connection between the first and second metatarsals, reducing motion at the first metatarsal-medial cuneiform joint.
• Magnetic resonance imaging confirmed a bony and cartilaginous coalition involving the first and second metatarsals.

Findings:

• Surgical resection of the coalition led to immediate improvements in the mobility of the first and second metatarsals, and the first metatarsal-medial cuneiform joint.
• The coalition resulted in a stiff first ray, causing increased plantar pressures under the first metatarsal head during ambulation.
• Abnormal foot kinematics associated with the coalition likely contributed to the patient's pain during walking and athletic activities.

Implications:

• Early diagnosis and surgical intervention for rare forefoot coalitions can effectively alleviate symptoms.
• Restoring normal foot kinematics through resection can improve function and reduce pain in affected individuals.
• This case highlights the importance of considering rare coalitions in the differential diagnosis of pediatric forefoot pain.