Disclosures: Deborah M. Pacik, MD, MPH: No financial relationships or conflicts of interest

Case Diagnosis: Osteoid osteoma of the lateral cuneiform.

Case Description or Program Description: A 27-year old male presented with left foot pain for two years with no inciting event. He was previously diagnosed with posterior tibial tendinopathy. Months later, he still had pain and started physical therapy (PT). An outside MRI showed bone marrow edema in the lateral cuneiform and mild posterior tibial tendinosis. A walking boot, more PT, then medicinal signaling cell (MSC) injections into the posterior tibial tendon provided no relief of his symptoms. An outside CT showed a small partially healed fracture on the lateral cuneiform with bony proliferative changes. He described sharp, stabbing, sometimes dull pain at the bottom of his left foot. The pain worsened with weight bearing, prolonged sitting, and at night. He was unable to play soccer or tennis. On exam he had limited ankle eversion and inversion secondary to pain. He was tender to palpation at the inferior medial malleolus, knot of henry, tibialis posterior tendon, cuboid, and lateral cuneiform. There was mild pain with mid-foot stress test and decreased ankle proprioception. Repeat CT showed an osteoid osteoma at the lateral cuneiform, with increased bony proliferation since prior outside imaging.

Setting: Academic Outpatient Office

Assessment/Results: Patient underwent CT guided radio-frequency ablation and biopsy with subsequent significant relief of symptoms.

Discussion (relevance): Osteoid osteoma is the third most common benign osteogenic bone tumor that typically affects males in their 2nd and 3rd decades. A common presentation is nocturnal pain relieved by NSAIDs. It can mimic other disorders, both clinically and on imaging. The typical radiological feature of osteoid osteoma is a central nidus accompanied by bony sclerosis and edema.

Conclusions: In a young patient with refractory nocturnal pain, osteoid osteoma should be on the differential.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/osteoid-osteoma-mimicking-posterior-tibial-tendinopathy-a-case-report/