Os peroneum imaging: normal appearance and pathological findings

Abstract

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. 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.

Diagnosis and Operative Treatment of Peroneal Tendon Tears

“…51 Approximately 20% of the population has an ossified os peroneum, visible on internal rotation oblique foot radiographs at the level of the calcaneocuboid joint. 1 Under physiologic conditions, the os peroneum should not appear proximal to the calcaneocuboid joint. 1 Migration of the os proximal to the calcaneocuboid joint is indicative of a tear of the peroneus longus tendon distal to the os peroneum.…”

“…1 Under physiologic conditions, the os peroneum should not appear proximal to the calcaneocuboid joint. 1 Migration of the os proximal to the calcaneocuboid joint is indicative of a tear of the peroneus longus tendon distal to the os peroneum. 53 If the tendon tear is associated with fragmentation of the os, the telltale fragment distraction can also be visualized on radiographs.…”

The peroneus longus muscle and tendon: a review of its anatomy and pathology

“…The os peroneum is a sesamoid bone within the peroneus longus tendon at the level of the calcaneocuboid joint. The origin of the os peroneum is controversial and could be related to a stress response, although cadaveric studies favor a developmental origin with a precursor to the os peroneum identified within embryonic feet [43]. The literature suggests that the embryonic os is chiefly fibrocartilaginous, and this tissue commonly persists without ossifying.…”

“…The os peroneum is ossified in only 20% of individuals. When ossified, it is bilateral in 60% of individuals [43]. It has variable size and morphology and can be bipartite (30% of cases) or multipartite.…”

Fifth metatarsal tuberosity avulsion fractures: a new surgical technique without metal implant

“…Excluding the bone anatomy, soft tissue around the 5MTB appear complex, indeed muscle and tendon structures are very important in the biomechanics of this kind of fractures. Distal to the Peroneal Tubercle (Ptub), the Peroneus Brevis Tendon (PBT) runs directly to insert into the base of the 5MTB, and the Peroneus Longus Tendon (PLT) curves beneath the cuboid, to reach the plantar region, which is usually attached to the first and second metatarsals (11). Has been described by Imre (12) anatomical variants of PBT and PLT insertions; regarding distal insertion of PBT Imre described six groups (Figure 3).…”