Myositis Ossificans Associated with Prayer Mark
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LETTER TO THE EDITOR
Myositis Ossificans Associated with Prayer Mark Alparslan Bayram C ¸ arlı1 • Ismail Co¨mertog˘lu2 • Hasan Turgut3
Ó Springer Science+Business Media New York 2016
Dear Editor, We read with great interest the article by Papadakis et al. [1] in which the authors studied prayer marks (PMs) in immigrants from Bangladesh with Diabetes who live in Greece. We would like to share our experience of a patient with myositis ossificans (MO) associated with PM, as no MO has been reported as a complication of PMs so far in the literature. A 50-year-old man presented to the outpatient department with a hard, palpable and non-compressible subcutaneous mass on the dorsolateral aspect of his left ankle (Fig. 1). He declared that the mass did not cause pain and it has gradually grown. He denied any history of trauma, surgery, bleeding disorder or any febrile illness prior to the onset of the mass, but declared that he was sitting on his feet on hard surfaces while praying. On physical examination, there was no sign of inflammation and no restriction of movements at the ankle. The nodule was not painful or itchy with palpation. Plain radiography revealed a radioopaque nodule over the lateral malleolus of the left ankle (Fig. 2). A diagnosis of MO associated with prayer nodule (or prayer mark) was made. The patient was advised to change his prayer practices, to use a soft prayer rug and to
undergo surgical excision of the mass if there is any cosmetic concern. Myositis ossificans (MO) is a reactive, non-neoplastic, extra-osseous bone formation of soft tissues, that mostly occurs following injury [2]. Repetitive minor trauma is also associated with the development of MO as in PMs [2]. Sitting on the feet while praying causes repetitive minor trauma leading to PMs. Furthermore, it must be kept in mind that sitting on the feet may also cause anterior tarsal tunnel syndrome (ATTS) which is an entrapment syndrome due to chronic prolonged stretching of the deep peroneal nerve on the dorsum of the foot during praying [3]. ATTS is characterized by paresthesia radiating to the first web space, pain in the dorsum of the foot, weakness in hyperextension of the toe, and in severe cases wasting of the
& Alparslan Bayram C¸arlı [email protected] 1
Department of Physical and Rehabilitation Medicine, GATA ¨ sku¨dar, Istanbul, Haydarpas¸ a Training Hospital, 34010 U Turkey
2
Department of Physical and Rehabilitation Medicine, Go¨lcu¨k Military Hospital, Kocaeli, Turkey
3
Department of Orthopedic Surgery, Bursa Military Hospital, Bursa, Turkey
Fig. 1 A hard, palpable and non-compressible subcutaneous mass on the dorsolateral aspect of the patient’s left ankle
123
J Immigrant Minority Health
immigrants who sit for prolonged times in cross-legged sitting position for meditation [5]. Compliance with Ethical Standards Conflict of interest
None.
Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research comm
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