title: Distal metatarsal coalition: A rare case report.
abstract: BACKGROUND
  Metatarsal coalition is an extremely rare condition. We report the second documented case of 4th and 5th distal metatarsal coalition in the literature.
  
  
  METHODS
  An eight-year-old girl was referred to an orthopaedic clinic with a four-month history of forefoot pain and swelling on the plantar aspect of the right little toe. Radiograph and clinical examination confirmed distal metatarsal coalition between the 4th and 5th metatarsals. Following a period of conservative treatment, excision was eventually performed due to worsening symptoms. Patient re-attended two years later with a recurrence of the coalition confirmed by computed tomography (CT) scan. The case was discussed at a tertiary paediatric orthopaedic insititution. Decision was made to manage patient conservatively with insole and physiotherapy until skeletal maturity. A year later, patient's symptoms did not worsen, and her foot displayed no evidence of change in the arch and shape.
  
  
  CONCLUSIONS
  The timing of ossification of coalition varies from one anatomical site to another. Surgery when performed before ossification is complete runs the risk of recurrence.
  
  
  CONCLUSIONS
  Our case report illustrates the importance of restoring normal weight bearing dynamics and pain relief when managing metatarsal coalition, or synostosis in skeletally immature patients. We recommend persevering with conservative treatment, with operative treatment reserved only as a later option, and ideally, until skeletal maturity is achieved.
authors: Trauma and Orthopaedics Department, Monklands Hospital, Airdrie, North Lanarkshire, United Kingdom. Electronic address: s.vun@nhs.net.
authors: Shen Hwa
authors: SH
authors: Vun
authors: Trauma and Orthopaedics Department, Monklands Hospital, Airdrie, North Lanarkshire, United Kingdom. Electronic address: edrampalos@yahoo.gr.
authors: Efstathios
authors: E
authors: Drampalos
authors: Trauma and Orthopaedics Department, Monklands Hospital, Airdrie, North Lanarkshire, United Kingdom. Electronic address: sajanshareef@gmail.com.
authors: Sajan
authors: S
authors: Shareef
authors: Trauma and Orthopaedics Department, Monklands Hospital, Airdrie, North Lanarkshire, United Kingdom. Electronic address: write2satya@hotmail.com.
authors: Satyajit
authors: S
authors: Sinha
authors: Trauma and Orthopaedics Department, Monklands Hospital, Airdrie, North Lanarkshire, United Kingdom. Electronic address: Diane.Bramley@lanarkshire.scot.nhs.uk.
authors: Diane
authors: D
authors: Bramley
keywords: Coalition; Conservative treatment; Distal metatarsal; Recurrence; Surgical treatment