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Heterotopic Ossification in the Residual Lower Limb in an Adult Nontraumatic Amputee Patient

Atkinson, George J. MD; Lee, Michael Y. MD, MHA; Mehta, Madhu K. MD

American Journal of Physical Medicine & Rehabilitation: March 2010 - Volume 89 - Issue 3 - p 245-248
doi: 10.1097/PHM.0b013e3181c5657c
Case Report: Amputee

Atkinson GJ, Lee MY, Mehta MK: Heterotopic ossification in the residual lower limb in an adult nontraumatic amputee patient.

Heterotopic ossification usually occurs in association with various neurologic injuries, trauma, and burns. There have been few reports in the literature of heterotopic bone formation at the distal residual limb in the adult amputee population. All previous cases with a documented cause have involved traumatic amputations. An adult diabetic patient who underwent left below-the-knee amputation for progressive Charcot foot is presented. The patient began to experience residual limb pain and decline in functional mobility 4–5 mos after surgery. Radiographs demonstrated heterotopic bone around the distal tibial and fibular remnant with extension into adjacent soft tissue. Triple-phase bone scan testing and tissue biopsy verified active heterotopic ossification. The patient was treated with etidronate and eventually was able to ambulate with a prosthesis on a regular basis. This case demonstrates that heterotopic ossification may occur and be a source of residual limb pain in the adult nontraumatic amputee population.

From the Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

All correspondence and requests for reprints should be addressed to George J. Atkinson, MD, Department of Physical Medicine and Rehabilitation, South Texas Veterans Health Care System, 1629 Treasure Hills Blvd, Suite B-5, Harlingen, TX 78550.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. This case was previously presented as a poster at the International Society of Physical Medicine and Rehabilitation Medicine (ISPRM), Sao Paulo, Brazil, April 10–15, 2005.

© 2010 Lippincott Williams & Wilkins, Inc.