Riddles in the diagnosis and treatment of osteoid osteoma in child foot: A concisive study.

Background: Osteoid osteoma in child foot is very unusual. We investigate its polymorphism and difficulties in approach.

Methods: We retrospectively studied 12 children (7 girls, 5 boys) treated in our department from February 1995 until February 2010. Mean age was 12 years (range 8-16 years) and average follow up time 5 years (3-8 years). The lesion affected mostly the talus (8 cases), calcaneus in 3 and once the fourth metatarsal. En bloc excision of lesion was the surgical method of choice.

Results: Children's symptoms lasted average 2 years (14 months to even 4 years). Nocturnal pain and relief with NSAIDs occurred only in half cases. Atypical symptoms were hip referring pain, tenosynovitis of foot extensors and achilles' tendon atrophy. Complete cure and no recurrencies were noted.

Conclusions: Diversity of symptoms and delay in diagnosis still remain troublesome and the absolute modality of treatment for child foot osteoid osteomas urges further investigation. Minimally invasive surgical techniques have recently emerged but orthopaedic surgeons must not forget that open excision remains the most safe and documented method for pediatric foot osteoid osteomas.