Os vesalianum treatment ideas

pgcarter · Jul 11, 2012

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Hi Folks,
I am looking for ideas about conservative care in relation to an Os vesalianum accessory bone at base of 5th met. Left foot 50's female otherwise basically healthy. Confirmed by imaging. Tried various shapes of felt padding to see if we can help it feel better but not having much success. On a pension so don't want to proceed to the cost of orthoses without being fairly sure it will help, and as yet I'm not convinced. Happy to have whatever feed back you have to offer......and opinions about the surgical option also.
regards Phill Carter

Admin2 · Jul 11, 2012

Related threads:
Other threads tagged with accessory bones
Proximal fifth metetarsal fractures
Fifth metatarsal stress fracture
Fifth metatarsal/styloid process pain
Fractured base of 5th or Os vesalianum pedis
Avulsion fracture of the styloid process?

pgcarter · Jul 11, 2012

Thyanks Craig, there's a few ideas in all that
regards Phill

NewsBot · Mar 28, 2013

A Rare Cause of Foot Pain With Golf Swing: Symptomatic Os Vesalianum Pedis--A Case Report
Massimo Petrera, Tim Dwyer, and Darrell J. Ogilvie-Harris
Sports Health: A Multidisciplinary Approach; 27 March 2013,

The os vesalianum is an uncommon accessory bone of the foot, located proximally to the base of the fifth metatarsal. It is usually asymptomatic and detected incidentally on radiographs. This is a case of bilateral os vesalianum, symptomatic only in the right foot, in a golf player. After a failed nonoperative treatment, the os vesalianum in the symptomatic foot was excised and the peroneus brevis tendon reattached using a suture anchor. The functional outcome was excellent, and the patient returned to golf 8 weeks after surgery.
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NewsBot · Apr 22, 2014

Symptomatic Os Vesalianum Pedis: Long-Term Follow-Up of a Rare Entity in Childhood
Serafin Garcia-Mata, MD
Journal of Foot and Ankle Surgery; Article in Press

Os vesalianum pedis is an accessory bone in the foot located proximal to the base of the fifth metatarsal within the peroneus brevis tendon, with a very low prevalence (0.1% to 1%), and is usually asymptomatic. Only 9 cases of symptomatic os vesalianum pedis have been reported. Other more common conditions should be ruled out. We found no reference to the condition in infants nor to its long-term evolution, such as was found in the present case. A 7-month-old male infant presented with a mass on the outer edge of his left foot. The mass had made it difficult to put on his shoe and had caused chaffing and tenderness in contact with the shoe. The infant would sometimes demonstrate facial grimaces of pain. Radiography revealed os vesalianum pedis. The bone fragment was excised. At 11 years, 5 months of age, the patient presented again, with reported pain of 8 months' duration in the same area, and a mass on the base of the fifth metatarsal of the left foot. Two years later, the patient was asymptomatic, with a normal lifestyle and sports activity, with occasional local chaffing. This evolution suggests that the best option in the case of an infant should be conservative treatment, given that the condition will usually be asymptomatic. If local bulging is evident, the possibility of recurrence, albeit with good prognosis, after excision should be explained to the parents.
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NewsBot · Apr 11, 2017

Symptomatic Os Vesalianum
A Case Report and Review of the Literature
Frank Timo Beil, Rolf D. Burghardt, Andre Strahl, Wolfgang Ruether, and Andreas Niemeier
Journal of the American Podiatric Medical Association: March 2017, Vol. 107, No. 2, pp. 162-165.

Os vesalianum is a rare accessory bone located proximal to the base of the fifth metatarsal in the peroneus brevis tendon. It is a radiographic diagnosis and mostly an asymptomatic incidental finding with a reported prevalence of 0.1% to 0.9%. Only 11 symptomatic cases have been described in the literature. Surgical therapy has been reported with good outcome in adults, whereas recurrence may follow excision during skeletal growth. We report a case of a 19-year-old girl with chronic weightbearing pain proximal to the base of the fifth metatarsal of her left foot. She first experienced exacerbated pain on increased loading when she started professional training as a shop assistant. Because several months of nonsurgical therapy failed, the decision was made to surgically excise the accessory bone from the peroneus brevis tendon via a longitudinal incision and a simple tendon-to-tendon reconstruction. Postoperative treatment consisted of using a walker to avoid weightbearing for 6 weeks, followed by a gradual return to full weightbearing as tolerated. At final follow-up, the patient was fully asymptomatic and was able to return to work. Citing this case, this article discusses differential diagnoses and treatment options for os vesalianum.
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NewsBot · Mar 1, 2019

Lateral foot pain due to os vesalianum pedis in a young football player; a case report and review of the current literature.
Aykanat F et al
Skeletal Radiol. 2019 Feb 27

Os vesalianum pedis is a rare accessory ossicle located at the 5th metatarsal base. This anatomic variation is typically asymptomatic and usually detected incidentally on routine foot radiographs. However, it may be a source of lateral foot pain and rarely become symptomatic following traumatic ankle injuries such as an inversion ankle sprain. To date, seven symptomatic os vesalianum pedis cases that required surgical treatment have been reported in the current literature. Herein, a 17-year-old professional football player with a symptomatic os vesalianum pedis was presented. The ossicle was surgically removed upon failure of conservative treatment. At the sixth month, the patient returned to sport without any restriction or pain. Clinical presentation, diagnosis, and treatment options of symptomatic os vesalianum pedis were discussed with an extensive literature review.
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NewsBot · Jan 19, 2020

Radiological Study on the Incidence and Clinical Importance of Os Vesalianum of 5th Metatarsal Bone
Muthiah Pitchandi, Mallikarjun Adibatti, V Bhuvaneswari
Source

Os Vesalianum (OSV) is an accessory ossicle of the foot, first described by Andreas Vesalius, during 1543 in “de humani corporis fabrica”. It is located proximal to the base of the fifth metatarsal bone within the peroneus brevis tendon, rarely symptomatic, detected incidentally on routine radiographs, with an incidence of 0.1% to 5.9%. OSV has rarely been implicated as a causative factor for lateral foot pain, peroneus brevis tendonitis and is commonly been misdiagnosed on routine radiographic examination as fracture of fifth metatarsal bone, due to the lack of knowledge pertaining to it.

Aim: To study the presence, incidence, location and morphology of OSV.

Materials and Methods: Retrospectively, 1000 radiographs both anteroposterior and oblique view of the foot was observed for the presence, incidence, location and morphology of OSV. Statistical analysis was done by descriptive statistics.

Results: In the present study, we observed an incidence of 1.5% of OSV, with predominantly round or ovoid shaped. OSV was more common in males than females in the present study, which was more often located on the posterolateral aspect of the base of fifth metatarsal and lateral to cuboid bone.

Conclusion: Orthopaedician and radiologists must be aware of such bony variants in the foot and ankle, which can serve as radiological pitfalls that can cause confusion leading to wrong diagnosis and delayed management in cases presenting with history of trauma and lateral foot pain.
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NewsBot · Feb 9, 2022

Lateral foot pain warrants an extensive diagnostic workup. A case of unilateral foot pain in the setting of bilateral os vesalianum in a soccer player
MihovilPlečko et al
Fuß & Sprunggelenk; 8 February 2022

Background
Os vesalianum (OV) is an accessory bone near the 5th metatarsal. It is usually asymptomatic, but might become painful.

Case Report
Nineteen-year-old soccer player with bilateral OVs complained of right foot pain after exercise. MRI showed no findings that would explain symptoms with certainty. Bone scan with SPECT-CT showed abnormal metabolism in both OVs, while increased blood flow was seen only in the right OV, confirming the cause of pain. After surgical removal of right OV the patient was symptom-free.

Conclusion
Broad diagnostic workup should be performed in patients with disabling foot pain and presence of OV to avoid unnecessary surgery.
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NewsBot · Aug 2, 2022

Knowing Your Accessory Foot Ossicles and Avoiding Misdiagnoses: A Case Report of Painful Os Vesalianum Pedis
Miguel De Castro Correia, Tiago Rodrigues Lopes
Cureus 14(7): e27380. doi:10.7759/cureus.27380

Os vesalianum pedis is located proximal to the base of the fifth metatarsal. Rarely, this accessory ossicle can be the source of lateral foot pain. There are very few cases of symptomatic os vesalianum pedis described in the literature, and most of them were surgically managed. We report a painful case of os vesalianum pedis managed conservatively. A 25-year-old professional soccer player presented with lateral left midfoot pain. There was no known acute sprain or trauma, and no history of injuries in the left lower limb. The athlete reported both mechanical and inflammatory pain findings and tenderness on the palpation of the fifth metatarsal base. We conducted a radiographic study of the left foot and found an image compatible with os vesalianum pedis. A right foot X-ray was also performed, and similar findings were reported, although the athlete had no pain. The athlete was treated conservatively, and the return-to-play was seven days.

Due to the unspecific symptoms of our athlete, many diagnoses could be considered such as peroneus brevis tendinopathy, lateral plantar fasciitis, ligamentum plantare longum sprain. However, the X-ray findings led us to other possible pathologies, mainly affecting the bone. Integrating clinical and radiological findings is mandatory to achieve a proper diagnosis and avoid mistakenly diagnosing a fracture such as a Jones fracture or pseudo-Jones fracture. Even though os vesalianum pedis is usually asymptomatic, this condition can lead to chronic pain. Well-designed conservative management should always be pursued to treat this condition as it might prevent the need for surgery.
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NewsBot · Sep 2, 2022

Knowing Your Accessory Foot Ossicles and Avoiding Misdiagnoses: A Case Report of Painful Os Vesalianum Pedis
Miguel De Castro Correia, Tiago Rodrigues Lopes
Cureus. 2022 Jul 27;14(7):e27380

Os vesalianum pedisis located proximal to the base of the fifth metatarsal. Rarely, this accessory ossicle can be the source of lateral foot pain. There are very few cases of symptomatic os vesalianum pedisdescribed in the literature, and most of them were surgically managed. We report a painful case of os vesalianum pedis managed conservatively. A 25-year-old professional soccer player presented with lateral left midfoot pain. There was no known acute sprain or trauma, and no history of injuries in the left lower limb. The athlete reported both mechanical and inflammatory pain findings and tenderness on the palpation of the fifth metatarsal base. We conducted a radiographic study of the left foot and found an image compatible with os vesalianum pedis. A right foot X-ray was also performed, and similar findings were reported, although the athlete had no pain. The athlete was treated conservatively, and the return-to-play was seven days. Due to the unspecific symptoms of our athlete, many diagnoses could be considered such as peroneus brevistendinopathy, lateral plantar fasciitis, ligamentum plantare longumsprain. However, the X-ray findings led us to other possible pathologies, mainly affecting the bone. Integrating clinical and radiological findings is mandatory to achieve a proper diagnosis and avoid mistakenly diagnosing a fracture such as a Jones fracture or pseudo-Jones fracture. Even though os vesalianum pedis is usually asymptomatic, this condition can lead to chronic pain. Well-designed conservative management should always be pursued to treat this condition as it might prevent the need for surgery.
Click to expand...

NewsBot · Sep 28, 2022

Os Vesalianum Pedis in a Young Adult: A Case Report and Literature Review
Alexander Muacevic, John R Adler, Vasileios K Mousafeiris, Ioannis Papaioannou, Nektaria Kalyva, Christine Arachoviti, Thomas Repantis
DOI 10.7759/cureus.14896 , Volume: 13 , Issue: 5 , Pages: 0-0

Os vesalianum pedis is a rare accessory foot ossicle. It is usually asymptomatic, however, it can be an infrequent cause of lateral foot pain. We present the case of a 19-year-old healthy male with lateral foot pain after an inversion-type injury. Initial X-rays were mistaken for fracture of the fifth metatarsal, however, a high index of suspicion for the presence of the os vesalianum led us to perform imaging of the contralateral foot; a mirror image with contralateral os vesalianum was revealed. The patient was treated conservatively and had an excellent outcome. In the context of trauma, os vesalianum must be differentiated from other causes of lateral foot pain, such as Iselin’s disease, avulsion fracture of the fifth metatarsal, Jones fracture, and others. Os vesalianum pedis is characterized as a rounded ossicle, with smooth edges, surrounded by cortical bone. Prompt diagnosis is essential as it changes the management.
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NewsBot · Nov 23, 2022

Resection of a Symptomatic Os Vesalianum with Peroneus Brevis Reattachment: A Report of 3 Cases and Literature Review of 100 Years
Stefan Rammelt, MD, PhD and Annika Pauline Neumann, MD
Source

Introduction/Purpose:
Os vesalianum is a very rare accessory foot bone located adjacent to the fifth metatarsal base. The estimated prevalence is below 1 %. In most cases it remains asymptomatic and is diagnosed as an incidental radiographic finding. Rarely the os vesalianum causes pain in the lateral midfoot. Therefore, only a few case reports about a symptomatic os vesalianum were published in the past. Here, we present what we believe to be the first small case series on that subject together with a review of the literature.
Methods:
Over a course of 10 years, we have treated three female patients (aged 18-36 years) who presented with pain on exercise in their lateral midfoot over the fifth metatarsal base. All of them had been diagnosed having a nonunion of the fifth metatarsal base, two after having sustained a direct or indirect trauma to the foot. The diagnosis of an accessory bone (os vesalianum) adjacent to the fifth metatarsal base fracture and with a joint facet to the cuboid bone could be made in retrospect in all cases by critically evaluating the initial radiographs. Technetium bone scans revealed an isolated increased uptake at the fifth metatarsal base. Upon surgical exploration, an irritation of the lateral facet of the cuboid with focal cartilage lesion through the accessory bone was noted in all 3 cases as a potential source of pain.
Results:
In all three cases, resection of the symptomatic os vesalianum and reinsertion of the peroneus brevis tendon into the fifth metatarsal base with a suture anchor was performed an led to a complete relief of pain within 3 months. At a minimum of 12 months follow-up all three patients fully returned to all previous activities including sports. The foot function index (FFI-D) improved from an average of 25.7 to an average of 3.67 at follow-up. One patient had a prominent subcutaneous suture knot removed, otherwise no complications were seen and no revision surgeries were needed in the further course. A systematic review of the literature revealed just 20 reported cases of a symptomatic os versalianum over 100 years (between 1922 and 2021). Previous treatment included observation, rest, resection with or without tendon reattachment, internal fixation and bone grafting.
Conclusion:
The knowledge of the location and morphology of accessory bones is indispensable when searching for rare causes of chronic foot pain. An os vesalianum may become symptomatic after direct and indirect trauma. The differential diagnosis must include an acute fifth metatarsal base fracture, non-union, or apophysitis (Iselin's disease), a distal peroneus brevis tendon lesion and lateral plantar fasciopathy. Resection of a symptomatic os vesalianum with reattachment of the peroneus brevis tendon to the 5th metatarsal base leads to a foot that is pain free and fully functional in most reported cases including the present series.
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NewsBot · Jul 13, 2023

Red Herring in Orthopedics: A Case Report on Painful Os Vesalianum Pedis Masquerading as an Avulsion Fracture of 5th Metatarsal and Review of Literature
Ashish Jacob Mathew et al
J Orthop Case Rep. 2023 Jun;13(6):74-78

Introduction: Os vesalianum pedis (OVP) is a rare accessory ossicle of the foot located proximal to the base of 5th metatarsal. It is usually asymptomatic but can mimic an avulsion fracture of proximal 5th metatarsal and is an infrequent cause of lateral foot pain. There have only been 11 cases of symptomatic OVP reported in the current literature.

Case report: Our patient, a 62-year-old male presented with lateral foot pain following an inversion injury of his right foot, with no history of any previous trauma. What was initially mistaken as an avulsion fracture of the 5th metacarpal base was later revealed to be an OVP on contralateral X-ray.

Conclusion: Treatment is mostly conservative, but surgical excision can be done in cases following failed non-operative treatment. In the context of trauma, OVP must be differentiated from other causes of lateral foot pain such as Iselin's disease and avulsion fractures of base of 5th metatarsal. Understanding the various etiologies of the condition and what those etiologies are usually related to can help prevent unnecessary treatment.
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