J Korean Foot Ankle Soc.  2024 Mar;28(1):31-35. 10.14193/jkfas.2024.28.1.31.

Medial Ankle Impingement Syndrome due to Talar Osteochondroma and Gout Attack: A Case Report

• Kyung MG
• Jeon D
• Lee DY

• KMID: 2553807
• DOI: http://doi.org/10.14193/jkfas.2024.28.1.31

Abstract

Osteochondromas are benign bone tumors typically found in the metaphyseal region of long bones. These tumors are often asymptomatic and detected incidentally. However, their occurrence in atypical sites such as the talus can pose significant diagnostic and treatment challenges. This report describes a rare case of osteochondroma of the medial tubercle of the talus, which is an unprecedented location based on a review of relevant literature. A 28-year-old male presented with worsening medial ankle pain and limping. Imaging revealed a lesion consistent with osteochondroma contributing to medial ankle impingement syndrome. Uniquely, this case also featured a coinciding gout attack in the ankle joint. Surgical removal of the lesion resulted in significant symptom relief and functional improvement. This case underscores the need to consider rare diagnoses, such as talar osteochondroma, when presented with persistent medial ankle pain and highlights the potential presence of concurrent conditions, such as gout.

Keyword

Osteochondroma; Talus; Gout; Impingement

Figure

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  Figure 1 Initial standing ankle (A) anteroposterior and (B) lateral radiographs demonstrating the presence of a bony protrusion (arrowhead) at the medial side of the talus.

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  Figure 2 Computed tomography images showing an osteochondroma occurring on the medial tubercle of the talus.

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  Figure 3 (A) T1- and (B) T2-weighted magnetic resonance images showing osteochondroma in the talus medial tubercle, a moderate amount of joint effusion with synovitis, and subcortical cysts in the medial malleolus.

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  Figure 4 Intraoperative medical photo. (A) Identification of the lesion (tip of the needle) by retracting the tibialis posterior tendon, (B) after complete excision of the lesion, (C) excised talar osteochondroma, and (D) gout tophi.

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  Figure 5 Microscopic slide view of (A) osteochondroma with a cartilage cap (H&E, ×400) and (B) deposition of needle shaped crystals indicating gout tophi (H&E, ×1,600).

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  Figure 6 Final standing ankle (A) anteroposterior and (B) lateral radiographs 6 months after surgery showing no recurrence.

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