A complicated Chiari type 1 malformation and holocord syrinx as a likely cause for heel pain

Robert Henderson, Rahul Lakshmanan, Aden J. McLaughlin, Omar Khan Bangash, Snigdha Saha, Richard Carey-Smith

Research output: Contribution to journalArticlepeer-review


Background Chiari malformations are a rare group of rhomboencephalic abnormalities involving the brain, craniocervical junction and spine. They may manifest in a variety of clinical presentations which relate to the variable involvement of the cerebellum, brainstem, lower cranial nerves, spinal cord and altered CSF flow dynamics.
Method We report an unusual case of incidental diagnosis of a type I Chiari malformation with secondary cystic cerebellar tonsillar encephalomalacia and holocord syrinx following investigation of a 5YO girl presenting with heel swelling related to progressive neuropathic osteoarthropathy of the posterior calcaneal body and apophysis.
Result The child was treated with decompressive suboccipital craniectomy and C1 laminectomy and tonsillar resection. Cerebellar tonsillar gliosis and cystic degeneration were confirmed on histopathology. Referral for ongoing engagement with occupational and physical therapy.
Conclusion Most type I Chiari malformations in the paediatric population are incidental and asymptomatic. Neurological symptoms are typically mild and relate to altered CSF flow dynamics; however, we present a complex case of type I Chiari malformation with an unusual constellation of associated complications.
Original languageEnglish
Pages (from-to)997-1003
Number of pages7
JournalChild's Nervous System
Issue number4
Early online date1 Feb 2024
Publication statusPublished - Apr 2024


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