Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2021; 9(25): 7445-7452
Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7445
Avascular necrosis of the first metatarsal head in a young female adult: A case report and review of literature
Ronald Wing Hei Siu, Jeremy Ho Pak Liu, Gene Chi Wai Man, Michael Tim Yun Ong, Patrick Shu Hang Yung
Ronald Wing Hei Siu, Jeremy Ho Pak Liu, Gene Chi Wai Man, Michael Tim Yun Ong, Patrick Shu Hang Yung, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
Michael Tim Yun Ong, Patrick Shu Hang Yung, The Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
Author contributions: Siu RWH contributed subject recruitment; Siu RWH and Liu JHP contributed subject assessment; Siu RWH, Liu JHP, Man GCW, Ong MTY and Yung PSH contributed drafting of the manuscript and data interpretation; Man GCW, Ong MTY and Yung PSH contributed administrative and material support; Ong MTY and Yung PSH contributed conception, design and supervision.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michael Tim Yun Ong, BSc, FRCS (Ed), MBChB, MSc, Assistant Professor, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Hong Kong 999077, China. michael.ong@cuhk.edu.hk
Received: April 27, 2021
Peer-review started: April 27, 2021
First decision: June 6, 2021
Revised: June 19, 2021
Accepted: July 19, 2021
Article in press: July 19, 2021
Published online: September 6, 2021
Processing time: 125 Days and 20.3 Hours
Abstract
BACKGROUND

This case study describes an atypical presentation of avascular necrosis (AVN) of the first metatarsal head, which is largely unfounded in the literature.

CASE SUMMARY

A healthy 24-year-old female initially presented with pain at the first metatarsophalangeal joint (MTPJ) and was diagnosed with AVN by physical examination and magnetic resonance imaging. The patient demonstrated atypically poor progress in recovery, despite being in otherwise good health and being of young age, with no history of corticosteroid or alcohol use. The patient also did not have any history or clinical features of autoimmune disease or vasculitis, such as systemic lupus erythematosus. The patient was managed with conservative treatment for 18 mo, which allowed for gradual return of full range of motion of the first MTPJ and subsiding pain, permitting the patient to return to high-intensity sports training and full weight-bearing. Throughout her recovery, many differential diagnoses were ruled out through specific investigations leading to further reinforcement of the diagnosis of AVN of the 1st metatarsal head.

CONCLUSION

Atypical AVN may occur with no predisposing risk factors. Treatment is mainly conservative, with unclear guidelines in literature on management.

Keywords: Avascular necrosis; Osteonecrosis; Metatarsal head; Atypical; Avascular necrosis; Young; Female; Foot and ankle; Sports medicine; Case report

Core Tip: Although idiopathic avascular necrosis (AVN) of the first metatarsal head is uncommon, its risk factors and clinical management can vary widely between sites. The present case of AVN of the first metatarsal head occurred in a 24-year-old female adult with pain in the first metatarsophalangeal joint. Initially, conservative treatment with analgesics did not show much improvement in relieving pain. However, after continuous treatment for 2 mo, the swelling subsided with reduced pain. After 4-mo of follow-up monitoring, improved range of motion of the first metatarsophalangeal joint was observed, but the pain had disappeared. No other complications developed during 18-mo of follow-up monitoring. The purpose of this case report is to indicate that an efficient and precise diagnosis of the patient’s case is important as it significantly changes the prognosis and management for such a condition.