Trophoneurotic changes in bones and joints in leprosy / Francis Harbitz.

  • Harbitz, Francis Gottfred, 1867-
Date:
1910
Catalogue details

Licence: In copyright

Credit: Trophoneurotic changes in bones and joints in leprosy / Francis Harbitz. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The third and fourth metatarsal bones are fused posteriorly, thin, and greatly shortened. On the outerside, they are joined by a bony plate 1.5 cm. long, which is probably a rudiment of the fifth metatarsal bone. At the anterior end of this bone is attached the first phalanx, 2 cm. long, with the second phalanx 1 cm. long. Specimen 10.—Lepra mutilans of one foot following an ulcerative inflamma- tion. Also concentric atrophy of the metatarsal bones and phalanges (Figs. 10 and 11). The specimen was obtained from a patient with lepra anesthetica who contracted the disease in 1852 and died in 1888. There had been ulceration of the sole of the left foot. The big toe had been disarticulated in 1882. The left foot was secured at the necropsy. It is greatly deformed, forming a lumpy mass, which is in strong, plantar flexion at the ankle. The tibia and fibula are fused for a distance of 5 cm. at the lower end, forming one pointed bone which has united to the remains of the tarsus. The latter consists mainly of the greater part of the calcaneum (7 by 4 by 3.5 cm.) of entirely irregular shape, and pointed anteriorly. To its inner side there adheres a small, smooth, flat piece of bone, Fig. 14.—Skiagraph; same as Fig. 1. evidently remains of the talus, and a splinter of bone adheres on the outside (remains of cuboid?). In addition, there remains of the tarsus only a flattened finger-bone, 3.5 by 2.5 cm., the origin of which can no longer be recognized. These marked changes in the tarsus are probably connected with the ulcerative and inflammatory process in the planta pedis. Of the metatarsus also, only fragments remain, partly in bony connection with the tarsus. The first metatarsal bone is missing, having probably been removed with the hallux. The second metatarsal bone is 2 cm. long and evenly reduced in all dimensions with a relatively large head. The third metatarsal bone is much smaller and thinner, and of the fourth one, only minute pieces are found. The fifth is unrecognizable. The toes are spread out in a fan-shaped manner from the small atrophic tarsus. The hallux is missing. In the second toe the first phalanx measures 2.4 cm. in length and is very thin at its middle; the second phalanx 0.7 cm. long and the third phalanx 0.7 cm. long, are about normal in size and shape. In the third toe, the first phalanx is 3 cm. long, thin and evenly atrophic; the second phalanx 0.9 cm. long, and the third phalanx 1.2 cm. long, are of about normal size and shape.