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Complete Bilateral Ankle Fusion: A Rare Complication of Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disorder primarily affecting the axial skeleton and is strongly associated with a positive human leukocyte antigen B27 (HLA-B27) genotype. Patients typically present with chronic low back pain that typically starts before the age of 40 years. Com...

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Autores principales: El-Fanek, Zaid, Gorbachova, Tetyana, Tan, Irene
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9478932/
https://www.ncbi.nlm.nih.gov/pubmed/36127992
http://dx.doi.org/10.7759/cureus.28094
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author El-Fanek, Zaid
Gorbachova, Tetyana
Tan, Irene
author_facet El-Fanek, Zaid
Gorbachova, Tetyana
Tan, Irene
author_sort El-Fanek, Zaid
collection PubMed
description Ankylosing spondylitis (AS) is a chronic inflammatory disorder primarily affecting the axial skeleton and is strongly associated with a positive human leukocyte antigen B27 (HLA-B27) genotype. Patients typically present with chronic low back pain that typically starts before the age of 40 years. Common initial clinical features include lower back, hip, and joint pain with stiffness that is worse in the morning and with inactivity. As the disease progresses over a prolonged period, it leads to fusion of sacroiliac joints and ankylosis of the vertebrae with the iconic "bamboo spine" on imaging. Joint fusion or ankylosis is the sequela of either undiagnosed or untreated AS. We report a case of a 69-year-old male with complete fusion of the ankle joint, hindfoot, and midfoot of both feet in the clinical context of an incidental finding of an ankylosed spine on computed tomography (CT) imaging. The ankle joint is a very uncommon site for fusion in ankylosing spondylitis. We would like to suggest the terminology “boot sign” for this rare radiographic finding of complete ankle and subtalar fusion given the appearance of a boot. “Boot sign” is associated with either inability to ambulate or a steppage gait from loss of ankle dorsiflexion as a result of ankle and hindfoot fusion with or without fusion of forefoot and midfoot.
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spelling pubmed-94789322022-09-19 Complete Bilateral Ankle Fusion: A Rare Complication of Ankylosing Spondylitis El-Fanek, Zaid Gorbachova, Tetyana Tan, Irene Cureus Radiology Ankylosing spondylitis (AS) is a chronic inflammatory disorder primarily affecting the axial skeleton and is strongly associated with a positive human leukocyte antigen B27 (HLA-B27) genotype. Patients typically present with chronic low back pain that typically starts before the age of 40 years. Common initial clinical features include lower back, hip, and joint pain with stiffness that is worse in the morning and with inactivity. As the disease progresses over a prolonged period, it leads to fusion of sacroiliac joints and ankylosis of the vertebrae with the iconic "bamboo spine" on imaging. Joint fusion or ankylosis is the sequela of either undiagnosed or untreated AS. We report a case of a 69-year-old male with complete fusion of the ankle joint, hindfoot, and midfoot of both feet in the clinical context of an incidental finding of an ankylosed spine on computed tomography (CT) imaging. The ankle joint is a very uncommon site for fusion in ankylosing spondylitis. We would like to suggest the terminology “boot sign” for this rare radiographic finding of complete ankle and subtalar fusion given the appearance of a boot. “Boot sign” is associated with either inability to ambulate or a steppage gait from loss of ankle dorsiflexion as a result of ankle and hindfoot fusion with or without fusion of forefoot and midfoot. Cureus 2022-08-17 /pmc/articles/PMC9478932/ /pubmed/36127992 http://dx.doi.org/10.7759/cureus.28094 Text en Copyright © 2022, El-Fanek et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Radiology
El-Fanek, Zaid
Gorbachova, Tetyana
Tan, Irene
Complete Bilateral Ankle Fusion: A Rare Complication of Ankylosing Spondylitis
title Complete Bilateral Ankle Fusion: A Rare Complication of Ankylosing Spondylitis
title_full Complete Bilateral Ankle Fusion: A Rare Complication of Ankylosing Spondylitis
title_fullStr Complete Bilateral Ankle Fusion: A Rare Complication of Ankylosing Spondylitis
title_full_unstemmed Complete Bilateral Ankle Fusion: A Rare Complication of Ankylosing Spondylitis
title_short Complete Bilateral Ankle Fusion: A Rare Complication of Ankylosing Spondylitis
title_sort complete bilateral ankle fusion: a rare complication of ankylosing spondylitis
topic Radiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9478932/
https://www.ncbi.nlm.nih.gov/pubmed/36127992
http://dx.doi.org/10.7759/cureus.28094
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