Fig 1- - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
A) Oblique radiograph of the right foot from June 2015 demonstrates an os peroneum at the expected level of the calcaneocuboid joint (arrow). The ossicle appears intact without evidence of fracture. (B) Oblique radiograph of the right foot from October 2012 demonstrates the os peroneum in a similar position (arrow).
Source publication
The os peroneum is an accessory ossicle within the peroneus longus tendon. Prior reports have discussed fracture of the os peroneum with associated tears of the peroneus longus tendon. When the ossicle fractures, there can be varying degrees of retraction of the tendon, which can be diagnosed by malposition of the ossicle or the ossicle fragments....
Similar publications
The incidence of peroneal tendon disorders in the population is unknown and they are usually overlooked. We report two cases of peroneus brevis injuries and a comprehensive literature review was performed. The first case was a 53-year-old man presented with persistent pain on the lateral aspect on the left ankle during the last four years and diffi...
Citations
... Its histologic structure is ossification, composed of fibrous tissue, cartilage, and bone [16]. Various foot pain caused by OP are defined as POPS, which results from fractures or diastases of multipartite os peroneum and damage in the peroneus longus tendon [17]. MRI images of POPS show edema of the bone marrow of OP and cuboid, as well as inflammatory changes of soft tissues [18]. ...
Hypertrophic peroneal tubercle (HPT) is an overgrowth of the peroneal tubercle located on the lateral aspect of the hindfoot, which could cause tenosynovitis of the peroneus longus tendon. Os peroneum (OP) is an accessory ossicle that exists in the peroneus longus tendon at the lateral aspect of the calcaneocuboid joint. Both HPT and OP can cause lateral foot pain and occasionally require surgical treatment. We encountered a case of lateral foot pain of HPT coexisting with OP. Careful preoperative magnetic resonance imaging, dynamic ultrasonographic image, and block injection suggested an impingement of HPT and OP as a cause of lateral foot pain. Surgical resection of HPT, while retaining OP, successfully achieved pain relief in the patient. To the best of our knowledge, this is the first report presenting a case of HPT coexisting with OP successfully treated without OP resection.
... Fracture and sclerosis were specific to the os peroneum; we associate this finding with the location of this accessory bone on the lateral edge of the foot, relating most to weight bearing and gait [34]. Fracture, osteonecrosis and secondary fragmentation can be explained by its location within the peroneus longus tendon at the edge of the foot and traction [35,36]. Peroneus longus tenosynovitis was often visible, possibly explained by direct contact or location within the tendon. ...
Purpose
The study was conducted to search for confident radiological signs in symptomatic cases of accessory bones. A normal accessory bone appearance on X-ray does not exclude that the accessory bone is the source of the discomfort; because of this, MRI examination can later be applied as part of the diagnosis.
Methods
We retrospectively analysed cases of 64 patients with recognized 70 symptomatic accessory bones of the foot. The average age was 29.2 (range 8–42) years. We included only patients with X-ray and MRI examinations. We investigated the following radiological features of the bone (structural and signal) in relation to soft tissue.
Results
The most constant symptoms identified in our study were bone marrow oedema (93%) and soft tissue oedema (77%). Changes in structures in which accessory bones were located or in adjacent structures to accessory bone were identified: tendon changes 51%, fluid adjacent to bone 51% and tenosynovitis 46%. MRI revealed changes in bone structure that are not seen on X-ray, including changes in contour (28%), sclerosis (3%) or osteonecrosis (3%).
Conclusions
MRI plays an important role in determining whether accessory bones cause symptoms because it shows specific and accurate changes in accessory bone and/or in adjacent soft tissue.
... The os normally retracts to the level of the IPR. An IPR tear allows for proximal migration to the lateral malleolus, with additional SPR tearing allowing for retraction into the lower leg [49]. ...
This article will review the anatomy and common pathologies affecting the peroneus longus muscle and tendon. The anatomy of the peroneus longus is complex and its long course can result in symptomatology referable to the lower leg, ankle, hindfoot, and plantar foot. Proximally, the peroneus longus muscle lies within the lateral compartment of the lower leg with its distal myotendinous junction arising just above the level of the ankle. The distal peroneus longus tendon has a long course and makes two sharp turns at the lateral ankle and hindfoot before inserting at the medial plantar foot. A spectrum of pathology can occur in these regions. At the lower leg, peroneus longus muscle injuries (e.g., denervation) along with retromalleolar tendon instability/subluxation will be discussed. More distally, along the lateral calcaneus and cuboid tunnel, peroneus longus tendinosis and tears, tenosynovitis, and painful os peroneum syndrome (POPS) will be covered. Pathology of the peroneus longus will be illustrated using clinical case examples along its entire length; these will help the radiologist understand and interpret common peroneus longus disorders.
... Generally, the proximally displaced bony fragment is entrapped anteriorly to the peroneal tubercle at the level of the inferior fibular retinaculum (inferior osteofibrous tunnel) [7]. Less frequently, with further tendinous retraction, the superior fibular retinaculum is injured and the bony fragment is displaced more proximally along the lateral fibula [13]. ...
We report the case of a 55-year-old male patient who presented to the emergency department after sustaining a right ankle trauma. Swelling and tenderness of the lateral aspect of the right ankle were present on physical examination without evidence of motor or sensory deficit. Ankle radiographs were performed and showed two bony fragments, the first located postero-inferiorly to the cuboid bone while the second was adjacent to the tip of the lateral malleolus. The diagnosis of an os peroneum fracture was made with high suspicion of an associated peroneus longus tendon rupture. Computed tomography (CT) and magnetic resonance imaging (MRI) of the right ankle confirmed the diagnosis of a subtotal retracted tendinous rupture. Successful surgical repair of the injured tendon was performed. This article illustrates the imaging findings of an os peroneum fracture with its associated tendinous injury and reviews the literature.
The os peroneum is an accessory ossicle located along the lateral aspect of the cuboid bone. Its position can serve as an indicator of peroneus longus tendon (PLT) injury. Imaging studies including radiographs and MRI can help detect malposition of the os peroneum and progressive injuries to the PLT and its associated structures. We report a case of a woman with recurrent foot and ankle pain, demonstrating progressive retraction of the os peroneum, implying severe PLT injury which may have ultimately predisposed her to a traumatic fifth metatarsal base fracture. This case highlights the importance of scrutinizing the appearance and position of the os peroneum on radiographs.
Painful os peroneum syndrome encompasses a spectrum of disorders associated with lateral foot and ankle pain. In the setting of an os peroneum fracture or diastasis of a partitioned os peroneum, marked displacement of the proximal fragment on radiographs is often used as an imaging surrogate for detection of a complete peroneus longus tendon tear. We present a case of a displaced proximal fragment of the os peroneum above the level of the ankle joint on radiographs and MRI associated with incomplete tear of the peroneus longus tendon. We hypothesize that such an injury pattern results from an anatomic prerequisite where the os peroneum occupies a portion of the cross-sectional diameter of the tendon. We suggest that the retracted proximal moiety of the sesamoid bone is the result of elastic recoil of delaminated fibers of the peroneus longus directly inserting on the os, whereas eccentric bundles of the tendon draping over the os remain in continuity. Although treatment implications are debatable, the case questions the assumption of a complete peroneus longus tear based on a retracted os peroneum on radiography and highlights the role of MRI in providing a full description.
Cavovarus deformity leads to increased peak pressure on the plantar lateral foot, which can lead to ulceration, and can potentially progress to amputation. Techniques have been suggested in the treatment of cavovarus deformity, such as peroneus brevis or longus tendon transfer, anterior tibial tendon lengthening, posterior tibial tendon transfer, or boney resection. This case series shows split anterior tibial tendon transfer as a surgical reconstruction of cavovarus pedal deformity. Our technique of split anterior tibial tendon in-phase transfer to the dorsal lateral foot, restores the eversion and dorsiflexory pull necessary to offset peroneal attenuation. The procedure can be performed primarily or staged, in order to achieve infection temporization prior to the transfer. A total of fourteen patients underwent split anterior tibial tendon transfer, 57.14% (8/14) of which had preoperative ulcerations, and 42.86% (6/14) of which had preoperative hyperkeratotic pre-ulcerative lesions. The preoperative ulcerations were present for an average of 67.89 weeks (range 2 to 232), with an average area of 6.09 ± 7.44 cm². The ulcerations healed in 75% (6/8) of the patients, at 19.67 weeks (range 1.57 to 76), with new ulceration occurrence in 7.14% (1/14) of patients, 7.14% (1/14) rate of ulceration recurrence. None of the patients went on to minor or major amputation. The goal of the tendon transfer is to decrease midfoot plantar pressures on the lateral foot and allow for resolution of pre-existing ulcerations and rebalancing the foot and ankle.
Clinical Level of Evidence: 4
Os peroneum is an accessory ossicle located within the peroneus longus tendon, present in 26% of the population. Fractures of the os peroneum present as pain localized on the lateral aspect of the foot resulting from direct trauma, muscle contraction, inversion injuries or chronic overuse injuries. We document a case of a fractured os peroneum that resulted in the insidious onset of ongoing pain that was managed conservatively.
Background: Spontaneous fracture of os peroneum with proximal retraction of peroneus longus tendon is a rare problem and the possibility of delayed or missed diagnosis arises. If left untreated it can be a cause of chronic lateral hindfoot pain. Case Report: This paper reports a 41 years old lady with 4 years history of lateral foot pain. Ultrasound and magnetic resonance imaging (MRI) revealed tendinitis of peroneus longus tendon (PLT) and she was treated with steroid injection. She presented to us with new pain over the lateral ankle. During surgery, fracture of os peroneum with retraction of PLT to level of lateral malleolus was found. The diseased tendon along with fractured fragment were excised and tenodesis with peroneus brevis was performed. Patient showed good symptomatic recovery. Conclusion: We aim to share our successful experience of surgical management of atraumatic os peroneum fracture which was retracted up to level of lateral malleolus. Fragmentation of os peroneum leading to fracture is not mentioned in literature, although there are very few reported cases of post traumatic os peroneum fractures. In patients with os peroneum syndrome with representation and remote symptoms, a high degree of suspicion should be considered for os peroneum fracture and proximal migration of fractured fragment.
