Distal metatarsal coalition: A rare case report

Area of Science:

• Orthopaedics
• Paediatric Orthopaedics

Background:

• Metatarsal coalition, specifically 4th and 5th distal metatarsal coalition, is an exceptionally rare condition.
• This report documents the second case of this specific coalition in medical literature.

Purpose of the Study:

• To present a case of 4th and 5th distal metatarsal coalition in a pediatric patient.
• To discuss the management strategies and outcomes for this rare condition in skeletally immature individuals.

Main Methods:

• A case study of an eight-year-old girl with a four-month history of forefoot pain and swelling.
• Initial conservative treatment followed by surgical excision due to symptom exacerbation.
• Subsequent conservative management with insoles and physiotherapy after recurrence.

Main Results:

• Initial surgical excision for 4th and 5th distal metatarsal coalition resulted in recurrence.
• Conservative management with insoles and physiotherapy led to symptom stabilization and no change in foot morphology.
• Computed tomography (CT) scan confirmed the recurrence of the coalition.

Conclusions:

• Surgical intervention for metatarsal coalition before complete ossification carries a risk of recurrence.
• Conservative management, including insoles and physiotherapy, is recommended for skeletally immature patients with metatarsal coalition.
• Operative treatment should be considered a later option, ideally after skeletal maturity is achieved.