Hereditary sensory radicular neuropathy : a family study / David C. Wallace.

  • Wallace, David C.
Date:
1970
Catalogue details

Licence: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)

Credit: Hereditary sensory radicular neuropathy : a family study / David C. Wallace. Source: Wellcome Collection.

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    Radiological Changes 25 roughening of the metatarsophalangeal joint surface. These are the only changes in this patient and are presumably the earliest evidence of bony abnormality. It is noteworthy that this is the part of the foot most exposed to weight-bearing trauma, forming as it does the base of both the longitudinal and transverse arches of the foot. One of the peculiar aspects of the radiological lesions is that some of the metatarsophalangeal joints are preserved when other sections of the same foot are completely disorganized. Thus, in one patient the fifth metatarsal with the base of the proximal phalanx capping it stood out alone and undamaged when all the remainder of the foot, including the more distal sections of the fifth digit, was very grossly abnormal. In fact, for the most part the bones were missing altogether. This patchy affection can have odd effects. In Case VI 99, in whom the foot was reduced to a shortened stump, one rather osteoporotic but otherwise normal phalanx stood among other unidentifiable remnants at the distal end of the tarsal bones. Figure 14: Bone changes in a case vrfthout trophic ulceration (Case VI 107). It is debatable whether these changes are independent of the trophic ulceration, but be that as it may, it is certain that infective changes occur. The bony ankylosis seen in several subjects is an example of this, as are the changes seen in the subperiosteal regions of the long bones (Figure 15). In this family the shafts of the metatarsals, except where the earlier described spindle-shaped osteolysis is occurring, seem for the most part to be fairly normal. It was interesting, in view of the sensory loss, to note that neuropathic changes of the type seen in Charcot's joints were not noted in the knees or ankles of any person in this series. One would have said that they did not occur, save for the appearance at the joint between the first cuneiform and the first metatarsal in the foot of one member of the family (VI 107). Here there was a disorganized \