Hello-
Here is another case I recently read, which I was previously ignorant of. I would not have been able to suggest the causative abnormality from the xray…I’ll be more clued into this in the future and hope by sharing, others (who were like me) will be able to as well.
2 yo old. Bilateral hallux varus. 1st proximal phalanx has a triangular or trapezoidal shape (known as a delta phalanx)
Bilateral T2W foot MRI. See aberrant longitudinal extension of the physeal cartilage along the medial aspect of the 1st proximal phalanx. The physeal cartilage has a "C-shape", known as a longitudinal epiphyseal bracket. This makes normal longitudinal growth of the proximal phalanx impossible, leading to the abnormally shaped phalanx and varus deformity. I think the MRI makes this easy to understand. The longitudinal component of the physis can be surgically resected, to allow for normal growth. There can be other coexisting congenital abnormalities of the digits. On this case, you may have also noticed the soft tissue syndactyly of the 2nd/3rd toes bilaterally.
Hope someone learns something from this, like I did.
Drew
