Talk:Paper - An infrequent developmental abnormality of the foot (1928)

ANATOMICAL NOTE

AN INFREQUENT DEVELOPMENTAL ABNORMALITY OF THE FOOT

By SYLVIA B. WIGODER, M.D. Assistant Radiologist, Mercer’s Hospital, Dublin

‘Tue cases of Pirie’s dorsal astragulo-scaphoid bone that have been described in English medical literature are far from numerous. Indeed, Pirie himself, in the Archives of Radiology for 1919, only recorded eight. The following case and the radiograms showing this condition may therefore be of interest.

The patient, Anthony ..., aged 27, was sent to the X-ray department for a suspected tubercular lesion of the right ankle. He stated that twelve years previously, when he was fifteen, he had been struck on the dorsum of the right foot by an iron girder. The lateral radiogram of the foot revealed a small piece of bone in the astragulo-navicular articulation, and this was also faintly indicated in the radiogram taken in the anterior posterior view. The left foot showed no abnormality when radiographed for comparison. It might be said that the abnormality was the result of his old accident, but against this are the facts that:

(1) The shapes of the astragulus and the navicular bones were quite normal.

(2) The bony outlines were quite distinct and sharply defined.

(3) There was no sign of injury to the other bones, and a girder falling across the whole dorsum of the foot is unlikely to fracture, and cause no displacement of only a small piece of bone lying at an articulation.

(4) In a fracture of this duration one would expect either some callus formation, or else complete absorption of such a small fragment.

(5) A small fragment of bone lying in this position would possibly cause pain, and until six months ago the patient suffered no disability.

The other theory that it is the congenital accessory ossicle of Pirie is more probable, as it resembles published illustrations of this condition.

Had the condition existed in both feet, no doubt would have existed as to the diagnosis, but although developmental abnormalities are usually bilateral, this is not always the case. Cervical ribs are frequently found on one side only, and of eight cases in which Pirie found this bone, in one only was it bilateral. He does not state, however, if both feet were always radiographed.

It is of interest to note that the radiograms of the wrist in this case show sesamoid bones at the metacarpal joints of the thumb, index and little finger, and also at the inter-phalangeal joint of the thumb.

I wish to thank Dr Garratt Hardman, the radiologist to this hospital, and Mr Maunsell, the surgeon in charge, for permission to publish this case. To the former also my grateful thanks are due for his kind and valuable assistance. 0S CALCIS--}---{--

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A. Outline of dorsal view of right foot.

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B. Outline of lateral view of right foot. ASTRAGALUS-~ --“e

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C. Outline of dorsal view of left foot.

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D. Outline of lateral view of left foot.