Hereditary sensory and autonomic neuropathy type IV orthopaedic complications.

Painless fractures with delayed healing or abnormal callus formation require exclusion of a systemic disorder. We report a 9-year-old girl with hereditary sensory and autonomic neuropathy type IV who developed bone changes in the hind foot after a protracted healing of a tibia fracture. Osteomyelitis was considered as a possible cause of destruction of the tarsal bones. Negative sweat test documented anhydrosis. Late diagnosis in our patient occurred because of an unusual clinical course of the disease.