Endocrine Abstracts

Introduction: We describe a patient with Fibrodysplasia ossificans progressiva (FOP) who developed an osteomyelitic neuropathic toe ulcer. This was treated effectively with conservative measures, but highlighted the need for multiprofessional working in managing patients with FOP.

Case: The patient’s toe ulcer occurred in 2017 and was initially managed by community podiatry and orthopaedics. The patient received multiple courses of antibiotics for recurrent infection. In 2018 they were reviewed in an endocrine clinic for a different reason whereby the osteomyeltic ulcer was highlighted. At the time the orthopaedic team were contemplating surgical debridement of the toe under spinal anaesthesia. A request for the patient to be seen in the diabetes foot clinic as an exceptional non-diabetic case was made. Initial assessment determined that there was a fixed flexion ankle deformity secondary to the FOP which was causing pressure on the first and second toes. Occupational Therapy were unable to provide a temporary device to offload such deformity and the orthotic department were asked to design a bespoke moulded insole with orthotic shoe. The infection was treated with a prolonged course of oral antibiotics and regular reviews. The combination of effective antibiotics and orthotic offloading has resolved the ulcer and osteomyelitis.

Discussion: FOP is an rare autosomal dominant condition in which there is a tendency for muscle and connective tissue to be replaced with bone, particularly in response to trauma. Specific dilemmas arose during treatment of this patient in terms of surgical and anaesthetic considerations, radiological imaging, monitoring for flares in FOP and subsequent advise to other professionals involved in the patients care, which recently included a dentist. The learning points from the management of this case could be applied to the treatment of other patients with similar challenges.