A SMALL AND PAINFUL PUZZLE

This case of osteoid osteoma is reported for two reasons. First, for i ts rarity and unusual location (it was diagnosed very late) and second because it demonstrates that the history of a painful condition leads to the correct diagnosis, and although clinical investigations may pr ovide corroboratory evidence, they are certainly no substitute. A 23-y ear-old student experienced spontaneous nightly pain in the distal pha lanx of his right hallux. The pain increased over 2 years but with a g ood response to non-steroidal anti-inflammatory medication. After 9 mo nths X-rays showed a cystic lucency, The patient was seen by a number of consultants, but the diagnosis of osteoid osteoma was delayed. Afte r surgery the diagnosis was confirmed histologically and the pain has not recurred.