However, a recent cadaveric study suggests that a precursor of the os peroneum is present in the fetal period in some patients. One proposed mechanism is from the non-union of secondary ossification centers. The origin of many of these ossicles is debated in the literature. Awareness of their presence and location is essential to limit the misdiagnosis of these normal variants for pathology. Īccessory ossicles are common, generally asymptomatic, normal variants seen throughout the musculoskeletal system, with several examples within the foot and ankle. Abnormalities in the morphology and location of the os peroneum can easily be identified on radiographs, specifically the oblique view, thereby elevating clinical suspicion for a peroneus longus tendon injury. Routine foot radiographs are a common first step in assessing lateral midfoot pain. Other causes of lateral midfoot pain also include ligamentous injury (talofibular or calcaneofibular), fractures of the base of the fourth or fifth metatarsal bone, anterior calcaneus, or cuboid. ![]() ![]() Painful os peroneum syndrome is a general term referring to conditions presenting as lateral midfoot pain associated with the os peroneum, such as acute fracture, stress fracture related to chronic repetitive trauma, contusion, avascular necrosis, or tendinosis, tenosynovitis, tendon tears, and subluxation involving the peroneal tendons. Like most accessory ossicles, os peroneum is generally asymptomatic and detected incidentally on imaging, though its intratendinous location can result in its involvement in pathologies affecting the peroneus longus tendon. Os peroneum is one of several accessory ossicles of the foot and ankle, located lateral to the cuboid within the distal peroneus longus tendon.
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