43 Case Report: A Novel Technique of Reconstruction Following Second and Third Ray Amputation and Excision of Lateral Sesamoid for Synovial Sarcoma of the Foot

Abstract

Synovial sarcomas primarily occur in soft tissues close to the joints and extremities. When they arise close to the hallucal sesamoids, which play a role in the static and dynamic weight process of the foot, present a management dilemma.

We report a case of a soft tissue synovial sarcoma of the foot in a previously fit and healthy 17-year-old individual without any history of trauma. MRI of the foot showed the tumour near the lateral sesamoids. Histology obtained by ultrasound guidance confirmed a diagnosis of primary synovial sarcoma.

After radio-chemotherapy, Patient had an en-block excision of the second and third ray of the foot as well as excision of the lateral sesamoid and lateral stabilizing structures of the first metatarsophalangeal joint with transposition of the extensor hallucis longus of the second toe to the cavity of the excised lateral sesamoid.

Following recovery, with a preserved first ray, patient is still able to walk, run and tiptoe walk. Patient also remains tumour-free at 5-year follow-up. We hope that the reconstruction option can be used in selective indications to restore lateral stability of first metatarsophalangeal joint (MTPJ).