Os Peroneum and Os Peroneum Syndrome: Difference between revisions
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The os peroneum is found within the peroneus longus in 26% of feet[1] and is a factor in the development of os peroneum syndrome.[2]
Anatomy
They are usually located plantar to the cuboid, lateral to the calcaneus, or at the calcaneocuboid joint.[3]
Pathophysiology
Os peroneum syndrome, also referred to as painful Os peroneum syndrome is a spectrum of conditions associated with an Os peroneum in the lateral foot. It can include the following:[4]
- acute os peroneum fracture or diastasis of a multipartite os peroneum
- chronic (healing or healed) os peroneum fracture or diastasis of a multipartite os peroneum with callus formation which can result in peroneus longus stenosing tenosynovitis.
- attrition or partial rupture of the peroneus longus tendon, proximal or distal to the os peroneum
- frank rupture of the peroneus longus tendon with discontinuity proximal or distal to the os peroneum
- presence of a large peroneal tubercle on the lateral aspect of the calcaneus which entraps the peroneus longus tendon and/or the os peroneum during tendon excursion leading to peroneus longus stenosing tenosynovitis.
Clinical Features
Patients complain of lateral ankle and/or foot pain.
Physical exam shows tenderness over the lateral plantar cuboid or at the calcaneocuboid joint. There may be thickening and tenderness of the peroneus longus tendons and peroneus brevis tendon sheath. Pain is exacerbated with the heel-rise phase of gait. Pain is also exacerbated by resisted plantarflexion of the first ray (first metatarsal and two phalanges of the great toe). The varus inversion stress test may provoke pain and this is performed by putting the foot in an inverted, supinated, and adducted position. Forced foot eversion may also cause pain.[3]
Investigations
Standard plain films show the Os peroneum (AP, lateral, mortise of the ankle, and AP and oblique of the foot). Also look for fracture, diastasis of multipartite Os peroneum, callus formation, proximal migration of the Os peroneum.[3]
Take care in not mistaking it for:[5]
- os vesalianum pedis
- os cuboideum secundarium
- apophysis of the 5th metatarsal
- avulsion fracture (pseudo-Jones fracture)
Treatment
First line treatments are rest, ice, and NSAIDs.
In severe cases immobilisation of the limb may be required.
The patient should also have a graded exercise programme.
References
- ↑ Peterson JJ, Bancroft LW. Os peroneal fracture with associated peroneus longus tendinopathy. AJR Am J Roentgenol. 2001 Jul;177(1):257-8. doi: 10.2214/ajr.177.1.1770257a. PMID: 11418450.
- ↑ Clarke HD, Kitaoka HB, Ehman RL. Peroneal tendon injuries. Foot Ankle Int. 1998 May;19(5):280-8. doi: 10.1177/107110079801900503. PMID: 9622417.
- ↑ 3.0 3.1 3.2 Sobel M, Pavlov H, Geppert MJ, Thompson FM, DiCarlo EF, Davis WH. Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Foot Ankle Int. 1994 Mar;15(3):112-24. doi: 10.1177/107110079401500306. PMID: 7951939.
- ↑ Weerakkody, Y., Luong, D. Os peroneum syndrome. Reference article, Radiopaedia.org. (accessed on 07 Mar 2022) https://doi.org/10.53347/rID-76408
- ↑ Gaillard, F., Baba, Y. Os peroneum. Reference article, Radiopaedia.org. (accessed on 07 Mar 2022) https://doi.org/10.53347/rID-7648
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
