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Osteochondral Lesion at the Proximal Phalangeal Base of the Hallux: A Case Report
Korean J Sports Med 2022;40:138-141
Published online June 1, 2022;  https://doi.org/10.5763/kjsm.2022.40.2.138
© 2022 The Korean Society of Sports Medicine.

Min Gyu Kyung1, Jeong-Gil Kim2

Departments of 1Orthopedic Surgery and 2Rehabilitation Medicine, Armed Forces Yangju Hospital, Yangju, Korea
Correspondence to: Min Gyu Kyung
Department of Orthopedic Surgery, Armed Forces Yangju Hospital, 1133 Hwahap-ro, Eunhyeon-myeon, Yangju 11429, Korea
Tel: +82-31-857-0963, Fax: +82-31-863-6465
E-mail: 20-14709@mnd.go.kr
Received November 30, 2021; Revised April 9, 2022; Accepted April 24, 2022.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Although osteochondral lesions are well-described in previous literature, lesions located at the proximal phalangeal base of the hallux are extremely rare. Here, the authors report the case of a 21-year-old male who presented with chronic right great toe pain, which was eventually diagnosed as an osteochondral lesion at the proximal phalangeal base of the hallux. The diagnosis presented herein should be kept in mind and included in the differential diagnosis when patients complain of chronic pain in the great toe.
Keywords : Cartilage, Hallux, Osteochondral lesions
꽌 濡

怨⑥뿰怨 蹂묐(osteochondral lesion) 愿젅 뿰怨④낵 뿰怨⑦븯 怨⑥쓽 넀긽씠 깮湲곕뒗 吏덊솚쑝濡 臾대쫷 愿젅뿉 媛옣 留롮씠 諛쒖깮븯硫, 뙏轅덉튂 愿젅, 諛쒕ぉ 愿젅뿉꽌룄 醫낆쥌 諛쒖깮븳떎怨 븣젮졇 엳떎1. 솚옄뱾 二쇰줈 愿젅넻쓣 샇냼븯硫, 愿젅 遺쐞媛 遺볤굅굹 愿젅 슫룞 踰붿쐞쓽 媛먯냼瑜 寃쏀뿕븯湲곕룄 븳떎2,3. 理쒓렐 옄뱾 臾댁 洹쇱쐞吏怨 湲곗遺뿉 諛쒖깮븳 怨⑥뿰怨 蹂묐쓽 利앸瑜 寃쏀뿕븯떎. 씠 遺쐞쓽 蹂묐 援궡뿉꽌 븘吏곴퉴吏 臾명뿄쑝濡 蹂닿퀬맂 諛 뾾쓣 젙룄濡 洹뱁엳 뱶臾쇨퀬, 臾댁쓽 쇅긽 썑 諛쒖깮븳 留뚯꽦쟻씤 넻利앹쓽 媛먮퀎吏꾨떒뿉 룄씠 맆 닔 엳쓣 寃껋쑝濡 湲곕븯뿬 蹂 利앸瑜 蹂닿퀬븯怨좎옄 븳떎. 蹂 뿰援щ뒗 援援곗쓽臾댁궗졊遺 쓽븰뿰援 쑄由ъ떖쓽쐞썝쉶쓽 듅씤쓣 諛쏆븯쑝硫(AFMC-202111-HR-087-01), 뿰援 긽옄 궗쟾 룞쓽瑜 뼸뿀떎.

利 濡

21꽭 궓옄 솚옄媛 2뀈 쟾 쑀룄瑜 븯떎媛 怨쇨뎬怨 넀긽쑝濡 諛쒖깮븳 슦痢 臾댁쓽 넻利앹쑝濡 궡썝븯떎. 媛꾪뿉쟻쑝濡 諛쒖깮븯뒗 넻利 븣臾몄뿉 냼뿼젣 蹂듭슜븯뒗 蹂댁〈쟻 移섎즺瑜 떆뻾븯떎. 궡썝 3媛쒖썡 쟾遺꽣 솢諛쒗븳 泥댁쑁 솢룞쓣 븯硫댁꽌 슦痢 臾댁쓽 넻利앹씠 젏젏 븙솕릺뿀쑝硫, 二쇰줈 蹂댄뻾 룞옉룞븞 臾댁媛 떊쟾맆 븣 넻利앹씠 떖빐吏꾨떎怨 븯떎. 씠븰쟻 寃궗뿉꽌 젣1以묒” 議깆 愿젅쓽 遺醫 냼寃ъ씠 愿李곕릺뿀怨, 愿젅쓽 슫룞 踰붿쐞뒗 떊쟾 15° 援닿끝 30°怨 嫄댁륫뿉 鍮꾪빐 愿젅媛룞踰붿쐞媛 媛먯냼릺뿀쑝硫, 닔룞쟻 떊쟾쓣 븷 븣 洹뱀떖븳 넻利앹쓣 샇냼븯떎. 臾댁뿉 異뺤꽦 븬諛뺤쓣 媛븯뿬 넻利앹쓣 쑀諛쒖떆궎뒗 뿰留 寃궗(grind test)뿉꽌 뼇꽦 냼寃ъ쓣 蹂댁떎.

蹂몄썝뿉꽌 떆뻾븳 泥댁쨷 遺븯 議깅 떒닚 諛⑹궗꽑 궗吏꾩뿉꽌 젣1議깆 洹쇱쐞吏怨⑥쓽 洹쇱쐞遺 愿젅硫 以묒떖뿉꽌 궡痢 諛⑺뼢쑝濡 뿰怨⑦븯 寃쏀솕 냼寃ъ씠 愿李곕릺뿀떎(Fig. 1). 而댄벂꽣떒痢듭눋쁺뿉꽌 吏곴꼍 9 mm 겕湲곗쓽 怨⑥뿰怨 蹂묐씠 二쇰쓽 젙긽쟻씤 뿰怨⑥뿉 쓽빐 옒 몮윭떥뿬 엳뒗 븞젙삎 蹂묐(contained lesion)씠 蹂댁쑝硫, 떆긽硫댁뿉꽌뒗 洹쇱쐞吏怨 湲곗遺뿉 옉 怨④레씠 솗씤릺뿀떎(Fig. 2). 옄湲곌났紐낆쁺긽쓽 T1 媛뺤“ 쁺긽뿉꽌 洹쇱쐞吏怨 湲곗遺뿉 쟾泥 愿젅硫댁쓽 빟 25%瑜 李⑥븯뒗 떊샇 媛뺣룄쓽 蹂묐씠 愿李곕릺뿀떎(Fig. 3).

Fig. 1. Plain radiograph showing subchondral sclerosis and lytic lesion of the subchondral bone (arrowheads).

Fig. 2. Computed tomography scan showing the lesion in the base of the proximal phalanx. Note that the lesion is a contained lesion.

Fig. 3. T1-weighted magnetic resonance imaging showing hypointense signal intensity at the proximal phalangeal base of the great toe.

솚옄쓽 蹂묐젰, 씠븰쟻 寃궗 諛 쁺긽쓽븰쟻 寃궗瑜 洹쇨굅濡 슦痢 臾댁 洹쇱쐞吏怨 湲곗遺쓽 怨⑥뿰怨 蹂묐쓣 吏꾨떒븯떎. 솚옄媛 洹몃룞븞 쟻젅븳 移섎즺瑜 諛쏆 紐삵뻽怨, 떦옣 닔닠쟻 移섎즺룄 씗留앺븯吏 븡븘 1李⑥쟻쑝濡 鍮꾩뒪뀒濡쒖씠뱶꽦 냼뿼젣 泥섎갑怨 븿猿 異⑸텇븳 쑕떇쓣 沅뚯옣븯쑝硫, 蹂댄뻾 떆 쟾議깅(forefoot)媛 怨쇱떊쟾 릺吏 븡룄濡 議깆 긽옄(toe box)瑜 蹂닿컯븳 떒떒븳 諛붾떏(outsole)쓣 媛吏 떊諛 李⑹슜쓣 沅뚯쑀븯떎. 뼢썑 蹂댄뻾 넻利앹쑝濡 뙆뻾(limping)씠 븙솕맆 寃쎌슦뿉 닔닠쟻 移섎즺瑜 怨좊젮븯怨 쇅옒 異붿떆瑜 怨꾪쉷븯떎.

怨 李

蹂 利앸뿉꽌 蹂닿퀬븳 臾댁 洹쇱쐞吏怨 湲곗遺쓽 怨⑥뿰怨 蹂묐 留ㅼ슦 씗洹븳 吏덊솚쑝濡, 臾댁 洹쇱쐞吏怨⑥쓽 썝쐞遺4,5 젣1以묒”怨⑤몢뿉 諛쒖깮븳 寃쎌슦뒗 紐 李⑤ 蹂닿퀬릺뿀쑝굹3,6, 洹쇱쐞吏怨 湲곗遺뿉 諛쒖깮븯뒗 寃쎌슦뒗 몢 嫄댁쓽 臾명뿄뿉꽌留 蹂닿퀬릺뿀떎2,7. Altman 벑2쓽 뿰援ъ뿉꽌뒗 鍮꾩튂궗而(beach soccer) 꽑닔쓽 젣1以묒” 議깆 愿젅 諛 젣1吏媛 愿젅뿉 諛쒖깮븳 93삁쓽 怨⑥뿰怨 蹂묐 以 洹쇱쐞吏怨 湲곗遺쓽 궡痢 20삁, 쇅痢 18삁瑜 蹂닿퀬븯떎. 븯吏留, 怨⑥뿰怨 蹂묐쓽 삎깭 源딆씠뿉 빐꽌 옄꽭븳 뼵湲됱 뾾뿀怨, 臾명뿄뿉 젣떆븳 洹몃┝ 二쇰 뿰怨⑥뿉 옒 몮윭떥뿬 엳뒗 븞젙삎 蹂묐蹂대떎뒗 愿젅 쇅痢 삉뒗 궡痢 걹(margin) 遺遺꾩쓣 移⑤쾾븯뒗 遺덉븞젙삎 蹂묐(shoulder lesion)씠뿀떎. Sherman 벑7 젣1以묒” 議깆 愿젅寃쎌쓣 씠슜븯뿬 洹쇱쐞吏怨 湲곗遺쓽 怨⑥뿰怨 蹂묐쓣 닔닠븳 닠湲곗뿉 빐 蹂닿퀬븯떎. 븘吏곴퉴吏 援궡뿉꽌 臾명뿄쑝濡 蹂닿퀬맂 諛붾뒗 뾾뿀떎. 씠젃寃 臾댁 洹쇱쐞吏怨 湲곗遺쓽 怨⑥뿰怨 蹂묐씠 씗洹븳 씠쑀뒗 젣1以묒” 議깆 愿젅硫댁쓽 몴硫댁쟻씠 옉怨, 二쇰줈 援닿끝怨 떊쟾쓽 떒씪 愿젅 슫룞쓣 븯硫, 洹쇱쐞吏怨 湲곗遺 愿젅硫댁쓽 以묒븰 遺遺꾩씠 뀒몢由 遺遺꾨낫떎 삤紐⑺븯뿬 넀긽맆 솗瑜좎씠 쟻湲 븣臾몄씠씪怨 깮媛곹븷 닔 엳떎.

蹂묒씤 떎瑜 쐞移섏뿉꽌 諛쒖깮븯뒗 怨⑥뿰怨 蹂묐怨 留덉갔媛吏濡, 諛섎났쟻씤 臾댁쓽 怨쇱떊쟾 삉뒗 怨쇨뎬怨≪뿉 쓽븳 넀긽씠 二쇱썝씤씠씪怨 븣젮졇 엳떎2,8. 蹂 利앸뒗 2뀈 쟾 臾댁媛 怨쇨뎬怨〓맂 긽깭濡 떎移 씠썑 젣1以묒” 議깆 愿젅쓽 留뚯꽦쟻씤 遺醫낆쓣 샇냼븯떎. 씠윭븳 留뚯꽦쟻 愿젅쓽 遺醫낆 愿젅쓽 솢븸留됱뿼 냼寃ш낵 洹쇱쐞吏쓽 삁瑜 怨듦툒쓣 떞떦븯뒗 쇅痢 議깆 룞留 遺꾩쓽 留뚯꽦쟻씤 넀긽뿉 쓽븳 寃껋쑝濡 꽕紐낇븷 닔 엳쓣 寃껋씠떎2,8.

쑀룄뒗 몴쟻씤 留⑥넀 諛 留⑤컻 寃⑺닾 뒪룷痢좊줈, 긽쓽 洹좏삎쓣 臾대꼫쑉젮 硫붿튂嫄곕굹, 뜕吏嫄곕굹, 꽆뼱쑉젮꽌 젣븬븯뒗 湲곗닠쓣 援ъ궗븯寃 맂떎9. 二쇰줈 뜕졇吏뒗 룞옉(being thrown)뿉꽌 떎移섍쾶 릺誘濡 샇諛 닔긽 遺쐞뒗 뼱源, 臾대쫷怨 넀媛씫쑝濡 븣젮졇 엳吏留10, Kim 벑11뿉 쓽븯硫 諛쒓낵 諛쒓씫쓽 닔긽 鍮꾩쑉룄 5.6%뿉 씠瑜몃떎怨 븯떎. 씠뒗 吏젢 洹좏삎쓽 썝由ш 以묒슂븳 硫붿튂湲곗 媛숈 湲곗닠쓣 援ъ궗븷 寃쎌슦9 諛쒓낵 諛쒓씫쓣 吏꺊븯뿬 긽瑜 꽆뼱쑉由ш린뿉, 臾댁媛 怨쇱떊쟾 삉뒗 怨쇨뎬怨 릺뒗 寃쎌슦媛 留롮쓣 寃껋씠씪 깮媛곷맂떎. 蹂 利앸뿉꽌룄 씠윭븳 뒪룷痢 넀긽씠 諛섎났쟻쑝濡 議댁옱븯뿬 臾댁 洹쇱쐞吏怨 湲곗遺뿉 怨⑥뿰怨 蹂묐씠 諛쒖깮뻽쓣 寃껋씠떎.

젣1以묒” 議깆 愿젅 蹂댄뻾 떆 뮮轅덉튂 뱾由(heel-off)怨 諛쒓씫 뱾由(toe-off) 궗씠뿉꽌 떊쟾씠 씠猷⑥뼱吏硫 젙긽 蹂댄뻾 떆 泥댁쨷쓣 吏吏븯怨 쟾諛⑹쑝濡 異붿쭊븯뒗 뜲 留ㅼ슦 以묒슂븳 뿭븷쓣 떞떦븯誘濡12, 젣1以묒” 議깆 愿젅뿉 諛쒖깮븳 怨⑥뿰怨 蹂묐 踰붿쐞媛 겕嫄곕굹 넻利앹씠 떖븳 寃쎌슦 蹂댄뻾뿉 겙 쁺뼢쓣 誘몄튌 닔 엳떎. Altman 벑2뿉 쓽븯硫 異붿떆 湲곌컙 以 몢 紐낆쓽 솚옄뿉꽌 젣1以묒” 議깆 愿젅뿼怨 臾댁 媛뺤쭅利앹씠 諛쒖깮븯뒗뜲, 蹂 利앸뿉꽌룄 而댄벂꽣 떒痢 珥ъ쁺쓽 떆긽硫댁뿉꽌 젣1以묒” 議깆 愿젅쓽 怨④레씠 愿李곕릺뼱 뼢썑 愿젅 媛뺤쭅쓽 쐞뿕꽦쓣 솗씤븷 닔 엳뿀떎. 뵲씪꽌 蹂 利앸뿉꽌뒗 怨⑥뿰怨 蹂묐뿉 쓽븳 넻利앸퓧留 븘땲씪 怨④레뿉 쓽븳 異⑸룎 利앺썑援곗뿉 쓽빐꽌 愿젅 슫룞 踰붿쐞, 듅엳 臾댁쓽 떊쟾씠 媛먯냼뻽쓣 寃껋쑝濡 뙋떒븷 닔 엳떎. 뼢썑 쇅옒 異붿떆瑜 넻빐 젣1以묒” 議깆 愿젅뿼쓽 吏꾪뻾 諛 臾댁 媛뺤쭅利앹씠 諛쒖깮븯뒗吏 뿼몢뿉 몢怨 愿李고빐빞 븷 寃껋씠떎.

移섎즺뒗 蹂댁〈쟻씤 諛⑸쾿遺꽣 떆뻾븷 닔 엳떎. 蹂 利앸뿉꽌 媛숈씠 슦꽑쟻쑝濡 異⑸텇븳 쑕떇怨 븿猿 鍮꾩뒪뀒濡쒖씠뱶꽦 냼뿼젣瑜 泥섎갑븯怨, 쟾議깅媛 옒 援щ윭吏吏 븡룄濡 議깆 긽옄(toe box)瑜 蹂닿컯븳 삎깭쓽 렪븞븳 떊諛쒖쓣 李⑹슜븯룄濡 沅뚯옣븷 닔 엳떎. 닔媛쒖썡 씠긽쓽 蹂댁〈쟻 移섎즺뿉룄 留뚯꽦쟻씤 넻利앷낵 뙆뻾씠 吏냽맂떎硫 닔닠쟻 移섎즺瑜 怨좊젮븷 닔 엳뒗뜲, 떎瑜 愿젅뿉꽌 깮湲곕뒗 怨⑥뿰怨 蹂묐泥섎읆, 굹씠, 蹂묐쓽 겕湲, 븞젙꽦 젙룄 諛 엫긽 利앹긽 벑뿉 뵲씪 쟻젅븳 諛⑸쾿쓣 꽑깮븳떎. 蹂묐쓽 踰붿쐞媛 옉怨 븞젙쟻씤 寃쎌슦뿉뒗 誘몄꽭 泥쒓났닠쓣, 踰붿쐞媛 겕怨 遺덉븞젙쟻씤 寃쎌슦뿉뒗 옄媛 怨⑥뿰怨 씠떇닠쓣 怨좊젮빐 蹂 닔 엳떎13. 臾댁쓽 洹쇱쐞吏怨 湲곗遺쓽 蹂묐뿉 빐꽌뒗 Altman 벑2씠 媛꾨떒븯寃 怨⑥뿰怨⑦렪쓣 젣嫄고븯뿬 뼇샇븳 엫긽쟻 寃곌낵瑜 蹂닿퀬븯쑝硫, 젣1以묒” 議깆 愿젅寃쎌쓣 씠슜븳 닔닠쟻 移섎즺 諛⑸쾿씠 냼媛쒕릺뿀떎7. 蹂 利앸뿉꽌뒗 젣1以묒”怨⑤몢쓽 怨⑥뿰怨 蹂묐뿉 빐 Delniotis Leidinger3媛 떆뻾븯뜕 옄媛 빐硫닿낏 씠떇 諛 뿰怨 뵾뙋 옱嫄댁닠쓣 떆룄빐蹂 닔 엳떎.

蹂 利앸瑜 넻븯뿬 臾댁쓽 쇅긽 썑 留뚯꽦쟻씤 넻利앷낵 遺醫낆쓣 샇냼븯뒗 솚옄뿉꽌 洹쇱쐞吏怨 湲곗遺쓽 怨⑥뿰怨 蹂묐쓣 쓽떖븷 닔 엳떎. 硫대븳 씠븰쟻 寃궗 쁺긽쓽븰쟻 寃궗瑜 넻빐 젙솗븳 吏꾨떒쓣 븯怨, 蹂댁〈쟻씤 諛⑸쾿쑝濡 癒쇱 移섎즺븯怨, 利앹긽씠 븙솕맆 寃쎌슦 닔닠쟻 移섎즺 諛⑸쾿쓣 媛뺢뎄븷 닔 엳쓣 寃껋씠떎.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Conceptualization, Data curation, Project administration, Visualization: MGK. Formal analysis, Methodology: All authors. Writing뱋riginal draft: MGK. Writing뱑eview & editing: All authors.

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