Talk:Paper - Rare congenital malformation of hands and feet (1924)

RARE CONGENITAL MALFORMATION OF HANDS AND FEET

By J. S. MANSON, M.D. Warrington.

H. F., the subject of the deformities to be described, is a railwayman in the permanent way department, who has always been able to perform his work efficiently. He is now 50 years of age.

Hands: Both hands show the same condition; the fingers are deviated to the ulnar side at the metacarpo-phalangeal joints which are prominent. There is distinct hollowing of the palms, and the Ist carpo-metacarpal joint is very prominent.

Skiagraph I shows bony condition of the right hand. The Ist metacarpal articulates laterally with the trapezium which is closely attached, if not altogether fused, to the base of the 2nd metacarpal bone. The condition of the left hand is precisely similar.

Skiagraph II shows bony condition of the left hand.

Feet: Both feet show the same features. On the dorsum there is a great prominence in front of the ankle joint, the toes are deviated outwards.’ The plantar aspect shows a very high plantar arch more correctly described as a hollow. The condition is an exaggerated form of pes cavus. Skiagraph III shows the bony condition of the left foot. The scaphoid stands up prominently on the dorsum, and its inferior border ends in a rather sharp wedge. The internal cuneiform is peculiar in shape, and seems partially fused to the base of the Ist metatarsal. The angle formed by the junction of the longitudinal axes of the os calcis and the 1st metatarsal is almost a right angle.

H. F. has 2 sons and 1 daughter. The elder son’s hands and feet are normal. The daughter has normal hands, and moderately high plantar arches, The younger son, aged 15 years, has well marked plantar arches in both feet.

Skiagraph IV shows bony condition of right foot in the younger son.

The parents of H. F. are alive, and their hands and feet were examined. The father was normal. The mother has very high plantar arches in both feet but no obvious abnormality of the hands, A sister has well marked plantar arches and normal hands. The feet and hands of two brothers who live in the locality are quite normal. One brother showed abnormal increase of movement

in the left thumb, but an X-ray plate showed the articulations to be quite normal, Rare Congenital Malformation of Hands and Feet 251

Skiagraph I

Skiagraph IT 252 : J. S. Manson

Skiagraph III

Skiagraph IV Rare Congenital Malformation of Hands and Feet 253

Comments: The variations in form and structure of the hands and feet in this case are in some degree correlated, and so far as the feet are concerned inherited and passed on to the third generation.

Evidently the condition arises in the germ cell: there is no suspicion that it is pathological or acquired.

Dwight (1) does not mention a similar condition of the hand in his monograph, and Dr Thurston Holland, of Liverpool, with his great experience of radiography has not seen it either, so that it may be considered excessively rare and worthy of record.

Partial fusion of the internal cuneiform with the base of the 1st metatarsal has been previously described by Thurston Holland(2), but I can find no reference in the literature available to me to the peculiar shape of the scaphoid with its wedge shaped border. Sir Arthur Keith, who has seen the prints, considers the condition one in which both bone and muscle are involved.

The question as to how far the variations in the hand are homologous with those in the foot in this case I would prefer to leave to expert anatomists,

I am greatly indebted to Dr Edward Fox of Warrington for the skiagraphs,

REFERENCES.

(1) Dwicut. Variations of the Bones of Hands and Feet, 1907. (2) Taurston Hottanp. “Two cases of rare deformity of feet and hands.” Archiv. of Radiology, Jan. 1918,