patient with osteoid osteoma; photos by Sydney Foot and Ankle Surgeon Damien Lafferty

This case will hopefully outline the importance of utilising all your knowledge and not solely relying on other professionals’ reporting.

I carried out bunion correction on this 25-year-old, 4 years ago, with an excellent outcome. He has then presented subsequently in a CAM boot with a 6-month history of severe midfoot pain and oedema. He has seen his podiatrist, physiotherapist, GP and sports physician. He had a previous MRI diagnosis of a stress reaction/fracture of the medial cuneiform given by the radiologist. I reviewed the previous MRI and a circumscribed lesion was present in the medial cuneiform with marked bone marrow oedema radiating out.

I suspected this was not a stress reaction/fracture and referred for a CT noting I suspected an osteoid osteoma was present (top left image). The radiologist concurred and the patient was booked for surgical excision. The lesion was removed (top right image) and the cavity was filled with a bone graft (bottom left image). Excellent radiographic graft insertion noted post-operatively (bottom right image). Histopathology confirmed.

The patient noted ALL pain resolved that night following surgery.

The take-home point from this is to look at every medical image yourself and “think outside the box” when treatments fail.

If you have any specific questions or would like to discuss similar cases, feel free to contact me.

(This content is intended for healthcare professionals only)