Retracted os peroneum with partial integrity of the peroneus longus tendon.

Skeletal Radiol

Department of Radiology, Einstein Healthcare Network, Part of Jefferson Health, Sidney Kimmel Medical College at Thomas Jefferson University, 5501 Old York Rd, Philadelphia, PA, 19141, USA.

Published: January 2024

AI Article Synopsis

  • Painful os peroneum syndrome involves lateral foot and ankle pain, often linked to a fracture or displacement of the os peroneum, which can indicate a potential peroneus longus tendon tear.
  • A case study showed a displaced os peroneum fragment above the ankle joint associated with an incomplete peroneus longus tendon tear, suggesting that the anatomy of the os peroneum plays a crucial role in injury patterns.
  • The findings challenge the reliance on radiographic indicators for diagnosing complete tendon tears and emphasize the importance of MRI for accurate assessment of os peroneum-related injuries.

Article Abstract

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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http://dx.doi.org/10.1007/s00256-023-04407-3DOI Listing

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