Intermittent, bilateral foot pain.
Bilateral foot x-rays
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1. Coned epiphysis of the proximal phalanges of the bilateral 2nd, 3rd and 4th toes may be a normal variation versus due to a bone dysplasia.
2. Mild hallux valgus deformity in the left foot.
3. Mild flaring of the base of the 2nd metatarsal bilaterally; may be a normal variation versus due to a bone dysplasia.
4. Bilateral pes planus (not shown here) was the likely cause of her pain.
1 case question available
Coned epiphyses can be a normal variation in the hand in the general population, most commonly affecting the 5th middle and 1st distal phalanges. However, it can also be associated with a number of conditions. The differential diagnoses can be summarized with the mnemonic, ABCD MOST:
- achondroplasia, acrodysostosis
- beckwith-Wiedemann syndrome
- chondroplasia punctata, Cockayne syndrome, conorenal syndrome (Mainzer-Saldino Syndrome, associated with chronic renal failure and phalangeal coned epiphyses of the hands), cleidocranial dysplasia, cartilage-hair hypoplasia
- dactylitis, Dyggve-Melchior-Clausen syndrome
- multiple epiphyseal dysplasia
- sickle cell disease
- thermal injury, trichorhinophalangeal syndrome
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center
- Amini, B. Cone-Shaped Epiphyses. Retrieved from http://roentgenrayreader.blogspot.com/2010/01/cone-shaped-epiphyses.html
- Hertzog, K. (1968). Cone-shaped Epiphyses in the Hand: Population Frequencies, Anatomic Distribution and Developmental Stages. Investigative Radiology, November/December.