Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2019; 10(11): 404-415
Published online Nov 18, 2019. doi: 10.5312/wjo.v10.i11.404
Synovial chondromatosis of the foot: Two case reports and literature review
Luca Monestier, Giacomo Riva, Placido Stissi, Mahfuz Latiff, Michele Francesco Surace
Luca Monestier, Giacomo Riva, Michele Francesco Surace, Orthopedic and Trauma Unit, ASST Settle Laghi, Varese 21100, Italy
Placido Stissi, Mahfuz Latiff, Residency Program in Orthopedics and Trauma, University of Insubria, Varese 21100, Italy
Michele Francesco Surace, Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese 21100, Italy
Author contributions: Monestier L and Riva G were the patients’ surgeons, reviewed the literature and contributed to manuscript drafting, Surace MF, Stissi P and Latiff M reviewed the literature and contributed to manuscript drafting, Latiff M analyzed the imaging findings; Surace MF, Monestier L and Riva G were responsible for the revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Michele F Surace, MD, Professor, Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences,,University of Insubria, Via Dunant 3, Varese 21100, Italy.
Telephone: +39-332-393670 Fax: +39-332-393651
Received: January 26, 2019
Peer-review started: January 28, 2019
First decision: March 18, 2019
Revised: May 17, 2019
Accepted: September 15, 2019
Article in press: September 15, 2019
Published online: November 18, 2019

Primary synovial chondromatosis (PSC) is a rare arthropathy of the synovial joints characterized by the formation of cartilaginous nodules, which may detach and become loose bodies within the joint and may undergo secondary proliferation. PSC of the foot and ankle is exceedingly rare, with only a few cases reported in the literature. The diagnosis may be difficult and delayed until operative treatment, when it is confirmed by histological assessment. PSC may degenerate into chondrosarcoma. Operative treatment is the gold standard aiming to minimize pain, improve function, prevent or limit progression of arthritis. Surgical treatment consists in debridement by arthrotomic or arthroscopic management, but there is no consensus in the literature about timing of surgery and surgical technique. Thus, the aim of this study is to report the outcomes of the surgical treatment of two cases, together with a literature review.


We report two cases of patients affected by PSC of the foot in stage III, according to the Milgram classification: the former PSC localized in the ankle that underwent open surgery consisted of loose bodies removal; the latter in the subtalar joint, and the choice of treatment was the arthrotomy and debridement from loose bodies, in addition to the subtalar arthrodesis. Both patients returned to complete daily and working life after surgery.


Synovial chondromatosis is a rare benign pathology, even rarer in the ankle joint and especially in the foot. Surgery should be minimal in patients with ankle PSC, choosing the correct timing, waiting if possible until stage III. More aggressive and early surgery should be performed in patients with PSC of the foot, particularly the subtalar joint, due to the high risk of arthritic evolution.

Keywords: Synovial chondromatosis, Foot, Ankle, Review, Treatment, Case report

Core tip: Synovial chondromatosis of the ankle and foot is a particularly rare, benign pathology. Despite the etiology remaining unknown, it can severely impair common daily activities of affected patients because of severe pain and limitation of joint motion. Surgical treatment should be performed in patients with Milgram’s stage III primary ankle synovial chondromatosis. Earlier surgery should be limited to primary synovial chondromatosis of the foot only, because of the higher frequency of subsequent degenerative pathologies.