PMC5306991_01
Plain radiographs and computed tomography showed no significant abnormality. (a) Anteroposterior radiograph of the foot. (b) Oblique radiograph of the foot. (c) Sagittal plane of the great toe in computed tomography.
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Plain radiography and computed tomography (CT) showed no significant abnormality (Figure 1).
Sagittal T1 and T2 weighted magnetic resonance (MR) images showed a nodule in the plantar capsule at the interphalangeal joint of the great toe and fluid retention around it and the flexor hallucis longus tendon. (a) T1 weighted MR image. (b) T2 weighted MR image. *Plantar capsule nodule. #Flexor hallucis longus.
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Magnetic resonance imaging (MRI) showed a single elliptical nodule in the plantar capsule at the IPJ of the great toe, distinct from the FHL tendon, and showed fluid accumulation in the IPJ and the tendon sheath of the FHL indicative of tenosynovitis (Figure 2).
Ultrasonography image of the interphalangeal joint (IPJ) showed fluid retention around the plantar capsule nodule and flexor hallucis longus tendon on the affected side, but not on the healthy side, of the great toe. (a) Affected side. (b) Healthy side. DP: distal phalanx and PP: proximal phalanx. *Plantar capsule nodule. #Flexor hallucis longus.
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FHL tendon on the affected side, but not the healthy side (Figure 3). From these observations we suspected that the stenosing tenosynovitis of the FHL was associated with the IPJ plantar capsular accessory ossicle.
Surgical resection of the plantar capsular accessory ossicle at the interphalangeal joint (IPJ) via medial approach. (a) The IPJ plantar capsular ossicle (arrow heads). (b) The constricted flexor hallucis longus tendon at the level of the IPJ plantar capsular ossicle (arrow heads). (c) Removed IPJ plantar capsular accessory ossicle.
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The nodule had the cartilaginous appearance at its intra-articular aspect (Figure 4). We opened a 3 mm length of the tendon sheath from its proximal end and visualized the FHL tendon at the level of the nodule (Figure 4).