A 32-year-old woman presented with a left great toe that had been gradually enlarging for the past 8 months. She reported dull, mild to moderate pain associated with the toe. The pain responded to aspirin and was not related to activity. Radiographs of the foot (Figure 1) showed a subtle lucency and mild hy-perostosis involving the distal phalanx. Magnetic resonance imaging (MRI) (Figure 2) showed a small nidus in the subungual area corresponding to the lucency on radiographs with marked surrounding bone marrow edema. The patient was referred to an orthopedic surgeon (A.D.) specializing in ankle-foot surgery. The decision was made to proceed with an intralesional curettage and excision. Intra-operatively, the approach was made through the nail bed, and a bulbous tumor coming from the distal phalanx was visualized dors ally. The lesion was completely curetted down to underlying cancellous bone. Histology revealed nidus tissue consistent with osteoid osteoma. The patient's symptoms completely resolved soon after the surgery.
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