Os peroneum

NewsBot · Jun 8, 2011

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Nonoperative treatment of an os peroneum fracture in a high-level athlete: a case report.
Smith JT, Johnson AH, Heckman JD.
Clin Orthop Relat Res. 2011 May;469(5):1498-501.

BACKGROUND: The os peroneum is a sesamoid bone in the peroneus longus tendon. Fractures of the os peroneum are rare. Some authors recommend surgery for active patients.

CASE DESCRIPTION: A 41-year-old male professional tennis coach sustained a minimally displaced fracture of the os peroneum. He was treated with restricted weightbearing for 2 weeks, followed by physical therapy and gradual return to activities. He returned to tennis 8 weeks after injury. Followup 7 years after the injury showed he had full strength, full motion, and a radiographically healed os peroneum. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score was 100 and Ankle Activity Score and Tegner Activity Level Scale were unchanged from those before injury.

LITERATURE REVIEW: Fracture of the os peroneum is a rare injury and treatment recommendations are based largely on very small series and case reports. Proposed treatment strategies for fracture of the os peroneum include nonoperative treatment, fixation of the fracture, excision of the bone with direct repair of the tendon, and tenodesis of the peroneus longus to the peroneus brevis.

PURPOSES AND CLINICAL RELEVANCE: Although some surgeons suggest fracture of the os peroneum should be treated operatively in active patients, this case shows nonoperative treatment allowed pain-free return to activities in a high-level athlete with a minimally-displaced fracture.
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Admin2 · Jun 9, 2011

Related threads:
Other threads on accessory bones

NewsBot · Sep 3, 2011

Sonographic evaluation and sonographic-guided therapeutic options of lateral ankle pain: peroneal tendon pathology associated with the presence of an os peroneum.
Sofka CM, Adler RS, Saboeiro GR, Pavlov H.
HSS J. 2010 Sep;6(2):177-81.

Clinical implications of acute injuries of the os peroneum have been described, with the recommendation in some cases being the excision of the bone fragments. We describe the spectrum of sonographic appearances associated with pain in the region of the os peroneum, document associated peroneal tendon pathology, and describe the use of sonography to direct and guide therapeutic and/or diagnostic injections. All sonographic examinations in our ultrasound database from Jan 1, 2001-Jan 30, 2007 with the words "os peroneum" were reviewed. Patients were cross-referenced in our radiology database to find relevant foot or ankle radiographs for correlation. There were 47 patients (18 men and 29 women, age range 16 to 83) referred for sonographic evaluation of lateral foot and/or ankle pain who had an os peroneum identified during the sonographic evaluation. Eighteen patients were referred specifically for targeted injection of the lateral ankle, including peroneal tendon sheath injections (N = 10), calcaneocuboid joint injections (N = 1), and injections around symptomatic os peroneum (N = 7). All 47 patients had tendinosis of the peroneus longus, in varying degrees of severity. Radiographs were available for correlation in 28 patients. The causes of lateral ankle pain with a co-existent os peroneum are multifactorial and may not directly relate to the presence of an os peroneum. Ultrasound can be of value in separating out the specific etiology for pain, as well as provide a method for problem solving by the performance of targeted diagnostic or therapeutic injections in the lateral ankle.
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NewsBot · Apr 18, 2012

Painful os peroneum syndrome presenting as lateral plantar foot pain.
Oh SJ, Kim YH, Kim SK, Kim MW.
Ann Rehabil Med. 2012 Feb;36(1):163-6.

Lateral plantar foot pain can be caused by various entities, and the painful os peroneum syndrome should be considered in the differential diagnosis. Recent developments in musculoskeletal ultrasonography are very useful for initial diagnosis. We discuss a 69-year-old female who experienced lateral plantar foot pain for over one month. Through physical examination, radiography, ultrasound and magnetic resonance imaging, she was diagnosed with the painful os peroneum syndrome with a chronic fatigue fracture of multipartite os peroneum and peroneus longus tenosynovitis, for which she underwent surgery. We herein report this rare condition and reviewed the relevant literature.
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NewsBot · Sep 7, 2014

Degenerative Arthritis of Pseudoarticulation between The OS Peroneum and Cuboid. A Rare Cause of Lateral Foot Pain
Kemal Gökkuş, Ergin Sagtas, Erkan Demirci, Murat Saylik, Ahmet Turan Aydın
Foot and Ankle Surgery; Articles in Press

Highlights
•The painful os peroneum syndrome is widely recognized. It is often the result of trauma.
•However degenerative changes between the os perineum and the articular facet is much rarer and we could only find two other case reports in the literature.
•This report concerns a middle aged woman with chronic plantar-lateral foot pain and a limp secondary to degenerative changes between the os peroneum and its articular facet with cuboid.
•The aim of this study is to remind to orthopaedic surgeons about painful os peroneum syndrome and to highlight the rarity of our case.
•In our case the mid term result of the excision of the os peroneum with painful articulation appear good, providing symptomatic pain relief with little alteration in the function of the foot.
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The painful os peroneum syndrome is widely recognized. It is often the result of trauma. However degenerative changes between the os perineum and the articular facet is much rarer and we could only find two other case reports in the literature.

This report concerns a middle aged woman with chronic plantar-lateral foot pain and a limp secondary to degenerative changes between the os peroneum and its articular facet with cuboid. The aim of this study is to remind to orthopaedic surgeons about painful os peroneum syndrome and to highlight the rarity of our case.

In our case the mid term result of the excision of the os peroneum with painful articulation appear good, providing symptomatic pain relief with little alteration in the function of the foot.
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NewsBot · Nov 18, 2014

Prevalence and Mophometry of Os Peroneum amongst Central Indians
PrAgAti S. MittAl, ShArdA S. JoShi, ruPA ChhAPArwAl, SubhASh d. JoShi
Journal of Clinical and Diagnostic Research. 2014 Nov, Vol-8(11): AC08-AC108 8

Introduction: Os Peroneum is round or oval shaped sesamoid within the substance of the Peroneus longus tendon as it plays on the Cuboid bone. Materials and Methods: Thirty six embalmed cadavers were dissected bilaterally. Lateral part of foot and sole was dissected to expose Peroneus longus tendon and Os Peroneum. Measurements of Os Peroneum and articular surfaces of cuboid (calcaneum) were taken by the Digital Vernier Caliper. Histological and Radiological Examinations of Os Peroneum were also done. Observation: A flattened oval enlargement i.e. Os Peroneum was found in all the tendons examined. The deep surface of Os Peroneum (i.e. articular surface) was concave, smooth and shiny; sometimes divided into two parts. There was a well
defined convex articular facet on the Cuboid at the proximal end of the peroneal sulcus, which sometimes extended proximally on to the Calcaneum forming a synovial joint. Results: Average length of Os Peroneum was found to be 13.35 mm (Right - 13.35 mm, Left - 13.35 mm). Average breadth of Os Peroneum was 8.96 mm (Right - 8.87 mm, Left - 9.05 mm). Average thickness of Os Peroneum was 4.11 mm (Right - 4.13 mm, Left - 4.10 mm). Incidence of double articular facets on cuboid and Calcaneum was more on the right side (25.80%) than the left (16.20%). Conclusion: Findings suggest that Os Peroneum is present at the site of angulations of Peroneus Longus tendon with attendant change in direction and the exposure to various stresses and strains leading to its thickening and formation of Os Peroneum.
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NewsBot · Jan 10, 2017

Os peroneum imaging: normal appearance and pathological findings
Stefano Bianchi et al
Insights into ; Imagingpp 1–10; 2017

The os peroneum (OP) is a small sesamoid bone located inside the peroneus longus tendon (PLT), close to the cuboid. The OP can be the cause of pain and can be associated with lesions of the PLT. OP involvement in PLT disorders is frequently misdiagnosed by radiologists. Painful os peroneum syndrome (POPS) refers to a variety of conditions presenting with pain localized on the lateral aspect of the cuboid area. The syndrome can be observed as a consequence of local acute trauma such as ankle sprains or chronic overuse. Because of its intra-tendinous location, in tears of the peroneus longus tendon, the OP can show changes in its morphology or position, depending on the location of the tendon’s tear. Based on the level of the PLT tears, we propose a classification in three subtypes: tears localized proximal to the os peroneum (type I), at its level (type II) or distal to it (type III). These tears present with different changes on OP morphology or location. The aim of this article is to review the normal anatomy, imaging appearance and differential diagnosis of disorders of the OP as well as post-treatment imaging.
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Teaching points
• PLT tears can be classified in three subtypes according to OP location.
• POPS is characterized by pain on the lateral aspect of the cuboid.
• OP involvement in PLT disorders is frequently misdiagnosed by radiologists.
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NewsBot · Dec 9, 2017

Progressive retraction of a fractured os peroneum suggesting repetitive injury to the peroneus longus tendon
Jennifer L. Favinger et al
Radiology Case Reports; 9 December 2017

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. We report a case of a man with recurrent eversion ankle injuries with progressive retraction of a fractured os peroneum, implying injuries to the superior and inferior peroneal retinacula and the peroneus longus tendon.
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NewsBot · Apr 28, 2019

The Os Peroneum incidence — a cadaveric study
Maribelda Rocha GomesaAndré PereiraPintobAlírio ArnoldoFabiáncTiago José MotaGomesdAlfonsNavarrodXavier MartinOlivae
Foot and Ankle Surgery; 27 April 2019

Highlights
•Os peroneum is a sesamoid bone sometimes present in peroneal tendons and it can be a source of pain on the lateral aspect of the foot.
•The incidence of Os peroneum reported in literature is highly variable; it mainly depends on the studied population and on the methods applied.
•Radiological, histological and cadaveric studies are useful for studying Os peroneum.
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Background
The Os Peroneum (OP) is a small sesamoid bone, which can be found in the Peroneus Longus Tendon (PLT) sheath, near the calcaneocuboid joint. Size and shape variability is quite common as well as a multipartite OP that can be found in some cases. Trying to explore and understand this variability, this study was carried out in order to provide us with answers about the presence and shape of OP in our specimens.

Methods
Twenty cadaveric lower extremities were obtained according to the body donation program of our institution. Dissections were performed to expose

the OP (when present) starting proximally at the origin of the PLT and Peroneal

Brevis Tendon (PBT) finalizing at the insertion of the PLT in the first metatarsal.

Results
In twenty feet, nine distinct OP were found, whilst six feet had a thickening of the tendon. On the remaining five foot, we did not identify an OP.

Conclusions
In this study, 45% of the feet analyzed had an OP. The authors believe the variability of OP prevalence reported in the literature can be associated with differences in its definition.
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NewsBot · Sep 18, 2019

Incidence and Clinical Implications of
Peroneal Sesamoid of the Foot
Muthiah Pitchandi et al
International Journal of Anatomy, Radiology and Surgery. 2019 Apr, Vol-8(2): AO38-AO40

Introduction: Os Peroneum (OP) is a sesamoid bone with an
incidence of 5-26%, located in the tendon of peroneus longus
adjacent to the lateral aspect of the cuboid bone. OP functions to
protect the peroneus longus but can actually be responsible for
peroneal tendon damage; acting as the focal point of mechanical
stress it can lead on to fracture. OP fractures may be difficult
to differentiate from the commonly encountered bipartite OP.
Plantar lateral foot pain is a common presenting complaint in
ankle sprain with many predisposing factors; pathology related
to OP is often overlooked and neglected.
Aim: To study the normal position, location, incidence,
distribution and morphology of OP in the radiographs of foot.
Materials and Methods: Retrospective 1000 radiographs of
the foot, both anteroposterior and oblique view were observed
for the presence, incidence, location and morphology of OP.
Statistical analysis was done by applying descriptive statistics.
Results: Incidence of OP was 10.2%, being more common
in males than females, with predominantly round or ovoid
shaped. OP was more often located on the lateral aspect of
calcaneocuboid junction.
Conclusion: Orthopaedician and radiologists must be aware
of such bony variants in the foot and ankle, in order to prevent
their misinterpretation, which assists as an aid in the early
evaluation and management of undiagnosed plantar lateral
foot pain.
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NewsBot · Oct 8, 2020

Fracture of an os peroneum
Michelle E Fabbro et al
J Can Chiropr Assoc. 2020 Aug;64(2):155-157.

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.
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NewsBot · Jan 12, 2021

Lateral Heel Pain Caused by Impingement of Hypertrophic Peroneal Tubercle and Os Peroneum
Ryosuke Takada et al
Case Reports in Orthopedics / 2021

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.
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NewsBot · Feb 5, 2021

Lateral Heel Pain Caused by Impingement of Hypertrophic Peroneal Tubercle and Os Peroneum
Ryosuke Takada et al
Case Rep Orthop. 2021 Jan 8

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.
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NewsBot · Oct 13, 2021

The anatomical variations of the lateral sesamoid bones of the foot: a retrospective
radiographic analysis
H. Kalbouneh et al

Background: Os peroneum and os vesalianum are sesamoid bones that could be found
within fibularis longus and brevis tendons, respectively. They are rarely a cause of lateral
foot pain and are often identified as incidental radiographic findings. However, in the
context of trauma, these sesamoids may be radiographically misinterpreted as fractures.
This study aimed to evaluate the prevalence and normal morphological variants of os
peroneum and os vesalianum.
Materials and methods: Standard oblique lateral and/or anteroposterior radiographic
views of 624 feet of adolescent and adult patients were retrospectively reviewed to
determine the prevalence and anatomical variations of the os peroneum and os
vesalianum.in relation to age and gender using plain radiography.
Results: Os peroneum was found in 22% and os vesalianum. was found in 1.6%. Age
was found to significantly correlate with the presence of os peroneum with the highest
prevalence (30%) detected in the elderly group. Among 137 feet with os peroneum,
54.0% were between 4 and 8 mm, 67.2%% were close to the tubercle of cuboid, 32.8%
were located at the level of calcaneocuboid joint, 81.8% were solitary, and 18.2% were
bi/multipartite. Among 10 feet with os vesalianum., Type I was identified in 40% and
Type II in 60%.
Conclusions: Different anatomical variants of the lateral sesamoid bones of the foot have
been described in this study. A thorough knowledge of normal anatomical variants is
essential for proper diagnosis and management and can enhance our diagnostic skills in
detecting these sesamoids
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NewsBot · Oct 10, 2022

Fifth Metatarsal Base Fracture Combined With Fracture of the Os Peroneum
Zheng Dan Wang, Hui Li, Lin Li, Quan Yu Dong, Xiao Heng Ding
J Am Acad Orthop Surg Glob Res Rev. 2022 Oct 6;6(10)

Fracture of the os peroneum is rare, and displacement of the fracture can be indicative of a tear in the peroneal longus tendon. A fifth metatarsal base fracture is a common injury caused by sudden inversion and plantar flexion of the hindfoot. We observed a rare case of a fifth metatarsal base zone I fracture combined with a displaced os peroneum fracture in a 34-year-old woman. The patient was treated with resection of the os peroneum and repair of the peroneal longus tendon, as well as open reduction and internal fixation of the fifth metatarsal base. After exposing the fragment of the fifth metatarsal base, the distal part of the fractured os peroneum was found to be located just under the fracture site. There were no complications or discomfort of the foot or ankle at 2 years postoperatively. Resection of the os peroneum and direct repair of the peroneal longus tendon were easily performed after the fifth metatarsal base fragment was exposed. This was an innovative method for performing peroneal longus tendon repair in the deep portion of the midfoot.
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NewsBot · May 16, 2023

Beyond the obvious: Exploring Os Tibiale Externum and Os Peroneum in Foot and Ankle Pain - A Case Series
Sindhura Yamajala, Sudhir Shankar Mane
J Orthop Case Rep. 2023 Mar;13(3):44-49

Introduction: Accessory ossicles are well-corticated bony structures found close to bones or a joint. They may be unilateral or bilateral. The os tibiale externum is also known as accessory navicular bone, os naviculare secundarium, accessory (tarsal) scaphoid, or prehallux. It is found within the tibialis posterior tendon near its insertion on the navicular bone. The os peroneum is a small sesamoid bone located within the peroneus longus tendon, adjacent to the cuboid. We present a case series of five patients with accessory ossicles of the foot to demonstrate pitfalls in the diagnosis of foot and ankle pain.

Case report: The case series includes four patients with os tibiale externum and one patient with os peroneum. Only one patient had symptoms related to os tibiale externum. The accessory ossicle in the rest of the cases was discovered incidentally after trauma to the ankle or foot. The symptomatic os tibiale externum was managed conservatively with analgesics and shoe inserts for medial arch support.

Conclusion: Accessory ossicles are considered developmental anomalies and they originate from ossification centers that have failed to fuse with the main bone. Clinical suspicion and awareness about the existence of the commonly occurring accessory ossicles of the foot and ankle are necessary. They can be a confounding factor in the diagnosis of foot and ankle pain. Failure to notice their presence might result in a misdiagnosis and unnecessary immobilization or surgery for the patients.
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NewsBot · Jul 25, 2023

Retracted os peroneum with partial integrity of the peroneus longus tendon
Brian Lee et al
Skeletal Radiol. 2023 Jul 24

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.
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NewsBot · Nov 21, 2023

The Association of Cavovarus Foot Deformity With an Os Peroneum
Nicolas H Zingas, Brandon W King
Foot Ankle Spec. 2023 Nov 20:

Objective: We sought to assess whether the presence of an os peroneum is correlated with cavovarus foot alignment in patients without a neurologic explanation for their foot shape. We hypothesized that a large os peroneum would increase the power of the peroneus longus and lead to a forefoot-driven, hindfoot varus deformity.

Materials and methods: This was a retrospective cohort study conducted at a single institution and reviewed patients with 3 weightbearing views of the foot on plain radiography. Patients were characterized into having either no os peroneum (235), a small os peroneum (18), or a large os peroneum (23). The control group included the first 101 of the 235 patients without an os peroneum based on a power analysis of the primary outcome, which was the difference in the mean Meary's angle (lateral talo-first metatarsal angle) between groups. The kite angle (anterior-posterior [AP] talocalcaneal angle), as well as 4 other angles were measured as secondary outcomes.

Results: Those with a large os peroneum had on a mean 7.7° (P < .01) more apex dorsal angulation of Meary's angle than controls, and a kite angle 4.2° varus to that of the control group. There were no differences between the small os peroneum and control groups.

Conclusion: These findings add to the existing literature surrounding the etiology of cavovarus foot shape and link the presence of an ossified os peroneum, an oftentimes incidental radiographic finding, to cavovarus foot deformity in those without an underlying neurologic diagnosis.
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NewsBot · Dec 17, 2023

Successful treatment of a painful os peroneum using conservative measures, infiltration therapy, and shock waves
Julian Ramin Andresen, Stephan Puchner, Sebastian Radmer
Journal of Surgical Case Reports, Volume 2023, Issue 12, December 2023, rjad645, https://doi.org/10.1093/jscr/rjad645

Lateroplantar foot pain may be caused by various entities, whereby painful os peroneum syndrome should be included in the differential diagnosis. Physical examination and multimodal imaging enable a definitive diagnosis. We report on a 59-year-old man with severe, load-dependent pain, corresponding to an os peroneum syndrome, triggered by a pes planovalgus with consecutively induced focal inflammation and tendovaginitis of the tendon of the peroneus longus muscle. Multifactorial conservative measures including infiltration and shockwave therapy finally led to a restoration of the original condition.
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NewsBot · Dec 22, 2023

Migration of the os peroneum: An enigmatic phenomenon explored through radiological perspectives
Caleb Bhatnagar et al
Radiol Case Rep. 2023 Nov 27;19(2):675-679

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.
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