Stenosing tenosynovitis and impingement of the peroneal tendons associated with hypertrophy of the peroneal tubercle.

We report three patients with lateral ankle and foot pain, with the diagnosis of stenosing tenosynovitis of the peroneus longus tendon associated with a markedly enlarged peroneal tubercle. Stenosing tenosynovitis of the peroneus longus tendon associated with an atraumatically enlarged peroneal tubercle has rarely been reported, and these reported cases were associated with an os peroneum. One of our patients had no demonstrable associated os peroneum but did have a bony tunnel enveloping the peroneus longus tendon. Our other two patients had an os peroneum, but were asymptomatic at the lateral outer border of the cuboid tunnel; one patient had involvement of the peroneus longus and brevis tendons.     

Bilateral Peroneus Longus Tendon Rupture Through a Bipartite Os Peroneum

Peroneus longus rupture with associated involvement of the os peroneum is an uncommon injury, and a small number of cases have been reported. Several mechanisms of injury have been suggested, but the most accepted theory is due to an inversion force placed on a cavovarus foot type. The sesamoid often becomes the focal point of the mechanical stresses and may fracture. Although the purpose of the sesamoid is to protect the tendon from rupture, the os peroneum may actually encourage fatigue (tear/rupture) under certain circumstances. Because this injury occurs at the cuboid notch, primary repair is complicated because of the inability to access the tendon as it courses deep within the midfoot. We present a bilateral case of peroneus longus rupture with involvement of the os peroneum in a patient with a cavovarus foot type. The injuries were sustained from an identical mechanism and occurred almost 1 year apart. In both situations, a peroneus longus to peroneus brevis tendon transfer was performed above the ankle joint in conjunction with partial excision of the fractured os peroneum. To the authors' knowledge, this is the only reported case of peroneus longus rupture associated with fracture of the os peroneum to occur bilaterally.     

Peroneus longus tendon rupture as a cause of chronic lateral ankle pain

Rupture of the peroneus longus tendon with an associated fracture of the os peroneum is an uncommon injury, which may present as chronic lateral ankle instability. There have been only seven cases documented in the literature since 1966. A case of chronic peroneus longus tendon rupture with os peroneum fracture is presented. The authors review their clinical, radiographic, and operative treatment of this patient and review the literature of this unusual injury.     

Subcutaneous Peroneus Longus Tendon Rupture Associated with OS Peroneum Fracture

We report a rare case of subcutaneous peroneus longus tendon rupture associated with os peroneum fracture. Three dimensional computed tomographic scan was useful to understand this disorder. We treated the patient with excision of fractured os peroneum and tenodesis of the proximal stump of the ruptured peroneus longus tendon to the lateral aspect of the calcaneus.

Key points

• In order to understand a rare case of subcutaneous peroneus longus tendon rupture associated with os peroneum fracture, three dimensional computed tomographic scan was useful.
• The patient was treated with excision of fractured os peroneum and tenodesis of the proximal stump of the ruptured peroneus longus tendon to the lateral aspect of the calcaneus.

Key words: Os peroneum, fracture, rupture, peroneus longus tendon.     

Significance of sesamoid ossification in peroneus longus tendon ruptures

Ruptures of the peroneus longus tendon are uncommon, with a small number of case reports found in published studies. The presence of an os peroneum can predispose the peroneus longus tendon to rupture at the cuboid level with or without concomitant fracture, or fracture through a partite os peroneum. Whether the os peroneum can be represented by various stages of ossification is still a matter of debate. We present 2 cases of acute peroneus longus tendon rupture at the cuboid notch in the presence of an intact os peroneum in the ossified and nonossified form. We treated patients with excision of the os peroneum and tenodesis of the peroneus longus to the peroneus brevis tendon.     

Spontaneous Fracture of the Os Peroneum With Rupture of the Peroneus Longus Tendon

Rupture of the peroneus longus tendon with or without an associated os peroneum fracture is rare and uncommonly encountered in the published data. Owing to the infrequent nature, a high index of suspicion is required. Otherwise, the opportunity for the injury to result in a delayed or missed diagnosis is increased. We report the case of a 39-year-old male with spontaneous rupture of the peroneus longus tendon and associated fracture of the os peroneum. The spontaneous rupture and fracture were diagnosed from the history, physical examination, and imaging findings. The patient elected to undergo operative repair, with excellent results, full recovery, and full return to normal function.     

Ruptur der Peroneus-longus-Sehne bei Os peroneum

Zusammenfassung Akzessorische Fußknochen und speziell das Os peroneum sind ein häufiger Nebenbefund am Fußskelett. Die Ruptur der Peroneus-longus-Sehne ist eher selten und tritt hauptsächlich bei vorgeschädigten Sehnen auf.Bei dem hier dargestellten Fall handelte es sich um einen knöchernen Ausriß der langen Peroneussehne mit darinliegendem Os peroneum bei einem Patienten mit chronischem Alkoholabusus.

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Rupture of the peroneus longus tendon with an Os peroneum. A case report

Accessory bones of the foot and specially the os peroneum are a frequently accidental finding in x-ray. A rupture of the peroneus tendon is rare and most times only to find at preinjured tendons.This case report shows a distal tearing out of the peroneus tendon from the bone with a supplementary os peroneum at a patient with chronical abuse of alcohol.

     

Sonographic Evaluation and Sonographic-Guided Therapeutic Options of Lateral Ankle Pain: Peroneal Tendon Pathology Associated with the Presence of an Os Peroneum

Clinical implications of acute injuries of the os peroneum have been described, with the recommendation in some cases being the excision of the bone fragments. We describe the spectrum of sonographic appearances associated with pain in the region of the os peroneum, document associated peroneal tendon pathology, and describe the use of sonography to direct and guide therapeutic and/or diagnostic injections. All sonographic examinations in our ultrasound database from Jan 1, 2001–Jan 30, 2007 with the words “os peroneum” were reviewed. Patients were cross-referenced in our radiology database to find relevant foot or ankle radiographs for correlation. There were 47 patients (18 men and 29 women, age range 16 to 83) referred for sonographic evaluation of lateral foot and/or ankle pain who had an os peroneum identified during the sonographic evaluation. Eighteen patients were referred specifically for targeted injection of the lateral ankle, including peroneal tendon sheath injections (N = 10), calcaneocuboid joint injections (N = 1), and injections around symptomatic os peroneum (N = 7). All 47 patients had tendinosis of the peroneus longus, in varying degrees of severity. Radiographs were available for correlation in 28 patients. The causes of lateral ankle pain with a co-existent os peroneum are multifactorial and may not directly relate to the presence of an os peroneum. Ultrasound can be of value in separating out the specific etiology for pain, as well as provide a method for problem solving by the performance of targeted diagnostic or therapeutic injections in the lateral ankle.     

Stress fracture of an os peroneum

Fracture of the os peroneum is relatively rare, and a stress fracture of the os peroneum is even rarer. We report a case of stress fracture of the os peroneum in a 38-year-old laborer who had been working in a crouching position. X-rays showed a multipartite os peroneum. Bone scintigram showed uptake at the os peroneum. The histology of the excised os peroneum revealed various stages of fracture healing. Excision of the fractured os peroneum and reconstruction of the peroneus longus tendon by end-to-end suture resulted in an excellent outcome.     

Os peroneum fracture with sural nerve entrapment neuritis

The os peroneum is a sesamoid bone contained in the peroneus longus tendon. When present, it usually is located at the plantar lateral aspect of the cuboid. The author presents a case of os peroneum fracture causing sural nerve entrapment. A review of literature is also presented.     

Surgical treatment of the symptomatic os peroneum

The os peroneum is an accessory bone found in approximately 10% of the population. It is located in the distal portion of the peroneus longus tendon adjacent to, or plantar to, the cuboid. The bone can become symptomatic when multipartite or fractured. If conservative measures fail, surgical excision of the ossicle is performed and provides symptomatic relief. A case of symptomatic os peroneum treated surgically is presented, with illustrations of the surgical technique.     

Nonoperative Treatment of an Os Peroneum Fracture in a High-level Athlete: A Case Report

Background  

The os peroneum is a sesamoid bone in the peroneus longus tendon. Fractures of the os peroneum are rare. Some authors recommend surgery for active patients.     

Role of the peroneal tendons in the production of the deformed foot with posterior tibial tendon deficiency.

Ten patients were identified with traumatic, complete common peroneal nerve palsy, with no previous foot or ankle surgery or trauma distal to the knee, who had undergone anterior transfer of the posterior tibial tendon to the midfoot. Six of these patients had a transfer to the midfoot and four had a Bridle procedure with tenodesis of half of the posterior tibial tendon to the peroneus longus tendon. Average follow-up was 74.9 months (range, 18-351 months). All patients' feet were compared assessing residual muscle strength, the longitudinal arch, and motion at the ankle, subtalar, and Chopart's joint. Weightbearing lateral X-rays and Harris mat studies were done on both feet. In no case was any valgus hindfoot deformity associated with posterior tibial tendon rupture found. It seems that the pathologic condition associated with a posterior tibial tendon deficient foot will not manifest itself if peroneus brevis function is absent.     

Management of foot pain associated with accessory bones of the foot: two clinical case reports

STUDY DESIGN: Case study. OBJECTIVES: To discuss the differential diagnosis, the nonsurgical and postoperative management of common accessory bones of the foot. BACKGROUND: Accessory bones of the foot that are formed during abnormal ossification are commonly found in asymptomatic feet. Two of the most common accessory bones are the accessory navicular and the os peroneum. Their painful presence must be considered in the differential diagnosis of any acute or chronic foot pain. The optimal treatment for the conservative and postoperative management of painful os peroneum and accessory navicular bones remains undefined. METHODS AND MEASURES: Therapeutic management of the fractured os peroneum included bracing, taping, and foot orthotics to allow healing of involved tissues, and stretching. The focus of the postoperative management of the accessory navicular was joint mobilization and progressive strengthening. Dependent variables included level of pain with provocation and alleviation tests of joint and soft tissue; girth and sensory tests of the foot and ankle; goniometric measures of foot and ankle; strength of ankle and hip muscles; functional tests; and patient's self-reported pain status. RESULTS: The patient with the fractured os peroneum was treated in 13 visits for 10 weeks. At discharge from physical therapy, the patient had the following outcomes relative to the noninvolved side: 100% return of normal sensation tested by light touch and vibration; pain decreased from 6/10 to 1/10; 100% reduction of swelling with ankle girth to normal; 100% range of motion of ankle and subtalar joints. Strength in plantar flexion and eversion remained 20% impaired (80% return to normal) secondary to pain. Upon discharge, he still reported mild pain when walking but was able to return to previous leisure activities. The second patient with the accessory navicular was treated in 18 visits over 9 weeks. Relative to the uninvolved side, she was discharged with the following: 70% return of range of motion in the foot and ankle, 100% of strength in hip and ankle, and 100% return of balance. She could squat and jump without pain and she returned to full premorbid activity level. CONCLUSIONS: Rehabilitative management of both cases addressed specific impairments and was successful in improving the patients' activity limitation. Clinicians should be aware that these accessory bones are possible sources of disability, secondary to foot pain.     

Longitudinal split of peroneus brevis tendon. A report on two cases

BACKGROUND AND AIMS: To describe the clinical findings and surgical treatment of peroneus brevis split. MATERIAL AND METHODS: Two cases of longitudinal split of the peroneus brevis tendon are reported. One of the patients was a healthy middle-aged woman, who had fallen out of a car in a traffic accident and sprained her right ankle. Lateral ankle sprain was diagnosed and treated with a compression bandage. Lateral ankle pain persisted, however, with some swelling in the peroneal tendon region. MRI revealed a longitudinal partial rupture of the peroneus brevis tendon, which was treated surgically 12 months after the trauma. The second case was a 53-year-old woman, who had been suffering from rheumatoid arthritis for 2 years. Chronic pain and swelling in the peroneal tendon region were treated with 6 local corticosteroid injections without significant relief. Preoperative ultrasonography showed effusion of the peroneal tenosynovium, but the operation revealed a longitudinal split in the peroneus brevis tendon. RESULTS: In the first case, a single central peroneus brevis split was repaired with side-to-side suturation. After four weeks with a below-knee cast the patient was allowed to walk freely. At follow-up 12 months postoperatively, she was satisfied, although she still had some exertion pain in her ankle. In the second case, the torn fragment of the peroneus brevis tendon was excised and the ankle was mobilized early. Healing was complicated by a wound fistula, which was treated with antibiotics. Subluxation of the peroneus longus tendon necessitated a reoperation, which revealed a rerupture and a defect of the peroneus brevis tendon. The subluxation was repaired and the ruptured tendon ends were revised, followed by four weeks of below-knee cast immobilization, after which the patient was allowed to walk freely. The outcome was good. CONCLUSION: Peroneus brevis split easily goes unrecognised or misdiagnosed. It must be considered in patients with a history of single or recurrent ankle sprain or a chronic inflammatory disease. Lateral ankle pain, diffuse or local swelling in the peroneal tendon region, and a stable or instable ankle with no peroneal weakness are the main symptoms and findings. MRI is the most exact method for diagnosing tendon split. Surgical treatment usually gives good results.     

Acute Compartment Syndrome after Non-Contact Peroneus Longus Muscle Rupture

This case demonstrates a rare variation in the pattern of injury and the presentation of acute lateral compartment syndrome of the leg. Although uncommon, lateral compartment syndrome of the leg after an ankle inversion leading to peroneus longus muscle rupture has been previously documented. This case was unusual because there was no overt ankle injury and the patient was able to continue physical activity, in spite of a significant rupture of the peroneus longus muscle that was determined later. This case highlights the necessary vigilance clinicians must maintain when assessing non-contact injuries in patients with possible compartment syndrome.     

Tendon Disorders of the Foot and Ankle

Attritional and traumatic injuries to the tendons around the foot and ankle are not uncommon. Treatment of overuse-type injuries (tendinitis) remains straightforward. However, surgical treatment of peroneal subluxation, Achilles tendon ruptures, and posterior tibial tendon insufficiency remains somewhat controversial. Generally speaking, soft-tissue reconstruction of the superior peroneal retinaculum is superior to bony procedures for peroneal dislocation. Open repair of a torn Achilles tendon is more predictable than closed treatment. Good clinical judgment is needed in determining the best treatment for posterior tibial tendon problems. The painful os peroneum syndrome is a newly described spectrum of posttraumatic conditions that may be the cause of lateral foot pain, which is frequently difficult to identify.     

Anatomical Factors Which Influence the Formation of Peroneal Tendon Tears: A Retrospective Comparative Study

This study aims to investigate the anatomical factors that are effective in the formation of peroneal tendon tears comparing with the control group. The patients with ankle magnetic resonance imaging (MRI) due to pain on the lateral side of the ankle were retrospectively analyzed using the clinical archive between July 2015 and January 2020. Peroneal tendon tears, peroneal tubercle type and size, presence of peroneal quartus, presence and type of retromalleolar groove, retromalleolar groove area, lateral malleolus type, presence of os peroneum, peroneus brevis-lateral malleolus distance (PBLMD), and accompanying pathologies in coronal, axial, and sagittal planes MRI were evaluated. PBLMD was measured as 27.1 ± 12.3 mm in Group 1. With PBLMD, it was measured as 39.6 ± 11.68 mm in Group 2. There was a significant relationship between low-lying peroneus brevis muscle and peroneal tear (p < .001). Peroneal tendon tear was more common in patients with peroneal quartus muscle (p < .001). There was a relationship between the retromalleolar groove type and the presence of peroneal tear (p = .004). More peroneal tears were observed in the concave retromalleolar groove type. The presence of concave type retromalleolar groove, peroneus quartus, and low-lying peroneus brevis muscle was found to be associated with peroneal tendon tears.     

Peroneus longus and brevis rupture in a collegiate athlete

Peroneal tendon injuries should be considered in the differential diagnosis of lateral ankle pain and instability. The spectrum of injury to the peroneal tendons includes tenosynovitis, tendinitis, subluxation, dislocation and tears. The mechanism, presentation and treatment of isolated peroneal brevis and longus injuries has been described in the literature. This is a case study of a rare combined peroneus brevis and longus injury in a young healthy collegiate athlete.