Coned epiphysis

Case contributed by Ava Sun


Intermittent, bilateral foot pain.

Patient Data

Age: 8 years
Gender: Female

Bilateral foot x-rays

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.

Case Discussion

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
  • osteomyelitis 
  • sickle cell disease 
  • thermal injury, trichorhinophalangeal syndrome

This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center   

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Case information

rID: 56742
Published: 5th Apr 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: David Geffen School of Medicine

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