Avascular necrosis of the first metatarsal head in a young female adult: A case report and review of literature

• Published in: World journal of clinical cases 2021, Vol.9 (25), p.7445-7452
• Main Authors: Siu, Ronald Wing Hei, Liu, Jeremy Ho Pak, Man, Gene Chi Wai, Ong, Michael Tim Yun, Yung, Patrick Shu Hang
• Format: Report
• Language: English
• ISSN: 2307-8960; 2307-8960
• DOI: 10.12998/wjcc.v9.i25.7445

BACKGROUNDThis case study describes an atypical presentation of avascular necrosis (AVN) of the first metatarsal head, which is largely unfounded in the literature. CASE SUMMARYA healthy 24-year-old female initially presented with pain at the first metatarsophalangeal joint (MTPJ) and was diagnosed with AVN by physical examination and magnetic resonance imaging. The patient demonstrated atypically poor progress in recovery, despite being in otherwise good health and being of young age, with no history of corticosteroid or alcohol use. The patient also did not have any history or clinical features of autoimmune disease or vasculitis, such as systemic lupus erythematosus. The patient was managed with conservative treatment for 18 mo, which allowed for gradual return of full range of motion of the first MTPJ and subsiding pain, permitting the patient to return to high-intensity sports training and full weight-bearing. Throughout her recovery, many differential diagnoses were ruled out through specific investigations leading to further reinforcement of the diagnosis of AVN of the 1st metatarsal head. CONCLUSIONAtypical AVN may occur with no predisposing risk factors. Treatment is mainly conservative, with unclear guidelines in literature on management.