Difficulties in diagnosing an osteoid osteoma of the big toe A case report with review of the literature

Background Osteoid osteomas belong to the benign osseous neoplasia and can occur on the entire skeleton. The prolonged diagnosis of an osteoid osteoma of the great toe prompted us to prepare a case report with a literature review to identify possible sources of error and to contribute to a more expeditious diagnosis and therapy. Literature Currently, only two case reports on osteoid osteomas of the toes are known in the German literature. Internationally, however, a large number of cases have been described, which, when viewed as a whole, present a homogeneous picture. A very clear accumulation of osteoid osteomas at the distal phalanx of the great toe suggests a possible post-traumatic aetiology. The typical NSAID-sensitive night pain is clinically unambiguous and should make one think of an osteoid osteoma at any site on the body. The symptom of macrodactyly, which is unique to the toes, is striking and may provide a helpful clue to establishing the diagnosis. The median time from symptom onset to correct diagnosis was 12 months. One possible reason for this prolonged diagnosis is the often atypical and ambiguous imaging. Surgical therapy is the method of choice for osteoid osteomas of the toes and should always be supplemented by histopathologic examination.