Calcific tendinopathy of the abductor Hallucis tendon in an adolescent gymnast

Case: A fifteen-year-old gymnast presented with right foot pain, noting tenderness to palpation about the right medial metatarsophalangeal joint prominence. Radiographs and magnetic resonance imaging raised concerns for a possible avulsion fracture of the head of the first metatarsal. Surgical exposure of the presumed fragment revealed chalklike material that was easily friable and seemed to emanate from the capsule. Pathologic evaluation confirmed dense fibrous tissue with calcification, consistent with a diagnosis of calcific tendinopathy. Conclusion: Calcific tendinopathy may occur in unusual anatomic locations, and must remain on the differential diagnosis for pediatric patients with the appropriate clinical picture.