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The coexistence of accessory navicular bone and os peroneum in an asymptomatic case 38-year-old woman. a Oblique radiograph shows accessory navicular bones (arrowhead), b oblique radiograph shows os peroneum (arrow)
Source publication
Most accessory ossicles and sesamoid bones of the ankle and the foot remain asymptomatic; however, they have increasingly been examined in the radiology literature, because they can cause painful syndromes or degenerative changes in response to overuse and trauma. Our aim was to document a detailed investigation on the accessory ossicles and sesamo...
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Citations
... The search and selection process of the articles is presented in Fig. 2 following the PRISMA guidelines. The majority of the studies (seven) analyzed ankles from the Middle East (Turkey or Jordan) [1,3,4,6,11,12,21], three studies stemmed from North America (USA) [15,18,41], two from Asia (Japan and China) [7,34], one from Africa (Egypt) [28], one from South America (Chile) [27], and one from Europe [29]. Three studies did not inform the region or country of origin of the studied sample [9,23,33]. ...
... Three studies did not inform the region or country of origin of the studied sample [9,23,33]. Most of the studies were conducted in radiographic images [1,3,4,6,11,15,27,34], six studies were conducted in a cadaveric/ dry bone sample [9,18,23,28,29,33], three studies in CTscan [7,11,41] and one in MRI [21]. The characteristics of the included studies are summarized in Table 1. ...
... There is significant divergence in the literature regarding the prevalence of the os trigonum, as it has been reported to be present in 1.7% [18], 2 to 13% [4,6,14,28,33], 25% [40], and 32.5% of cases [41]. However, the present metaanalysis revealed a prevalence of 10.3% in a sample of 17,626 ankles. ...
Purpose
the os trigonum is a supernumerary bone that may lead to posterior ankle impingement syndrome. The present study aims to assess the prevalence of this bone.
Methods
A meta-analysis regarding the presence of the os trigonum was performed. For this, the MEDLINE and SciElo databases were searched using “os trigonum” as the keyword. Only original articles, theses, books, dissertations, and monographs were included. Papers with a sample size of < 50 individuals were excluded. The data extracted from the articles were: the total sample size, the prevalence of the trigonum, the method of analysis, the region of the sample, and data regarding sex and side (left or right). Statistical analysis was performed using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium). The heterogeneity between the studies was assessed using the I² estimation and the Cochran Q test. For all analyses, a random effect was used and a value of p < 0.05 was considered significant.
Results
249 papers were found, while 18 were included in the meta-analysis. A total of 17,626 ankles were included. The pooled prevalence of the os trigonum was 10.3% (95% CI 7–14.1%) in the present study. There was no significant difference regarding sex or side, while studies conducted in imaging exams showed a higher prevalence in comparison to cadaveric studies.
Conclusion
Our results suggest that the os trigonum is relatively common. Knowledge of the prevalence of the os trigonum may help surgeons and clinicians diagnose posterior ankle impingement syndrome.
... The os peroneum is a roundish oval accessory bone, which is located as a sesamoid bone in the distal half of the tendon of the peroneus longus muscle on the plantar side of the os cuboideum [1]. Along with the os trigonum and the os tibiale externum, the os peroneum is one of the most common accessory bones in the tarsal region and is found in the normal foot skeleton with an incidence of 3.9%-30% [1][2][3][4], depending on the literature. In 30% of cases, the os peroneum appears in two parts and in 60%, it is bilateral [5]. ...
Lateroplantar foot pain may be caused by various entities, whereby painful os peroneum syndrome should be included in the differential diagnosis. Physical examination and multimodal imaging enable a definitive diagnosis. We report on a 59-year-old man with severe, load-dependent pain, corresponding to an os peroneum syndrome, triggered by a pes planovalgus with consecutively induced focal inflammation and tendovaginitis of the tendon of the peroneus longus muscle. Multifactorial conservative measures including infiltration and shockwave therapy finally led to a restoration of the original condition.
... Therefore, the localization and dimensions of the accessory bones should be well known to avoid misdiagnosis. Misdiagnoses cause excessive workload, additional costs, and unnecessary treatment services (1,2). ...
... tomography images taken in emergency departments or clinics. Therefore, knowing the normal and/or abnormal variations of bone structures in the lower extremity and various radiological pitfalls that may cause confusion is the primary objective of our study (1,3). ...
... Knowing the normal dimensions, especially at the first presentation to the hospital, will reduce the likelihood of fracture. The incidence of mtp2 (12.92%), mtp3 (0.68%), mtp4 (2.04%) and mtp5 (23.12%) sesamoid ossicles was similar to the literature (1,4,26). ...
Aim: Accessory and sesamoid bones are hidden anatomical structures that fulfil a wide variety of functions in the human body. Therefore, studying the nature, formation and dimensions of these structures is of great importance for the medical literature. In our study, we aimed to measure the presence and area (size) of these ossicles. Material and Method: Our study was performed retrospectively on the images of individuals who applied to Ordu University and whose radiological images were obtained. The presence of accessory and sesamoid ossicles (present/absent) and their sizes (measured using the PACS system) were evaluated on radiographs and CT images. The results of the ossicles were divided into gender, age, and bilateral groups. Statistical analyzes were performed with the SPSS program. Results: The most common and largest accessory ossicles in the foot were os peroneum (18.2%), os naviculare accessoria (17.4%), os trigonum (12.1%) and os intermetatarsarum (7.8%). Sesamoid ossicles at the level of the first metatarsophalangeal joint of the foot and the first metacarpopgalangeal joint of the hand were found to be 100% common. The second most common sesamoid bone in the hand and foot was at the fifth mtp (22.22%) and mcp (68.53%) joints. In the hand, the most common accessory ossicles were os triangulare (6.08%), os radiale externum (2.60%) and os centrale (1.73%). Accessory ossicles (fabella: 19%, cyamella: 17.5%) were found in 25.5% of the knee. Conclusion: Accessory and sesamoid ossicles are most commonly found in the hand, foot, and knee. The presence and size of these ossicles can be both beneficial and harmful. Sesamoids provide mechanical benefit, whereas accessory ossicles can be mistaken for fractures and may lead to unnecessary medical conditions. Knowing the dimensions of these ossicles allows them to be clinically differentiated from avulsion fractures.
... The sesamoid bones can also be present within the tendons, for example, posterior tibial and anterior tibial tendons. 1,2 Most sesamoid bones of foot remain asymptomatic. 1 Sometimes they can be associated with pain because of various pathologies like trauma, infection, inflammation, degenerative changes, or even rare conditions like osteonecrosis. 2 Sesamoids are small bony structures that are either partially or completely embedded in a tendon. ...
Sesamoids are small bony structures that are either partially or completely embedded in a tendon. Sesamoid bones are found at multiple places in body but most common sites are in foot, with the most consistent location being the metatarsophalangeal joint of great toe. Various pathologies affecting the sesamoid bones of hallux can be a cause of long-standing forefoot pain and discomfort. Imaging helps in diagnosis of these conditions at an early stage. Imaging also helps in differentiating these pathologies from normal variants like bipartite sesamoid bone.
... The accessory navicular (AN) bone is a frequently encountered accessory bone, located posteriorly to the navicular bone and often present bilaterally (1). It represents a secondary ossification center of the navicular bone and is inherited as an incomplete autosomal dominant trait, with an incidence rate ranging from 4% to 21% (2)(3)(4). ...
Purpose
To investigate the clinical efficacy of modified kidner procedure combined with subtalar arthroereisis in the treatment of adolescent type II painful accessory navicular with flexible flatfoot.
Methods
From January 2018 to January 2022, 25 adolescent patients (40 feet) with painful type II accessory navicular and flexible flatfoot admitted to our hospital were enrolled in the study, including 13 males (23 feet) and 12 females (17 feet). All patients underwent modified kidner procedure combined with subtalar joint arthrodesis. The Meary's Angle, the first metatarsal Angle of talus (APTMT), the second metatarsal Angle of talus, Pitch Angle, talus tilt Angle, talonavicular coverage Angle (TCA), talus calcaneal Angle (LTCA), and calcaneal Angle were measured on weight-bearing anteroposterior and lateral x-ray films before operation and at last follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) were used to evaluate the improvement of foot function and pain.
Results
All patients were followed up for average 17.4 ± 2.6 months (12–24). The incisions of 25 patients healed by first intention. The weight-bearing anteroposterior and lateral x-ray films of the foot showed that the suture anchors did not pull out or break, and the foot arch did not collapse further. There was no screw withdrawal or secondary operation to remove the screw in all patients. At the last follow-up, the postoperative visual analogue scale (VAS) score of the affected foot was significantly lower than that before operation ( P < 0.01), and the American Orthopaedic Foot and Ankle Society (AOFAS) foot function score was significantly higher than that before operation ( P < 0.01). At the last follow-up, the weight-bearing anteroposterior and lateral foot x-ray films showed that: The Meary's Angle, the first metatarsal Angle of the talus (APTMT), the second metatarsal Angle of the talus, Pitch Angle, talar tilt Angle, talonavicular overbite Angle (TCA), talocalcaneal Angle (LTCA), and calcaneal Angle significantly improved when compared with those before operation ( P < 0.01).
Conclusions
The modified kidner procedure combined with subtalar arthroereisis has a good clinical effect in the treatment of adolescent type II painful accessory navicular with flexible flatfoot, which can effectively improve the pain symptoms, improve the foot function and imaging manifestations, and correct the flatfoot deformity.
... Another hypothesis proposes that the origin of the OVP is a fracture of the fifth metatarsal tuberosity [6]. One of most generally accepted hypotheses, which is reinforced by the fact that the OVP has articular cartilage, states that it is a true sesamoid bone [15]. OVPs are a rare source of discomfort of the lateral foot. ...
... The ossicle is encircled by cortical bone and has a spherical form with smooth edges. The OVPs articulation with the cuboid bone, however, is its standout feature [10,11,12,15]. Since the fracture line is acute and the bone fragment lacks cortication, the foregoing characteristics are not present in fractures of the fifth metatarsal base [9]. ...
Introduction:
Os vesalianum pedis (OVP) is a rare accessory ossicle of the foot located proximal to the base of 5th metatarsal. It is usually asymptomatic but can mimic an avulsion fracture of proximal 5th metatarsal and is an infrequent cause of lateral foot pain. There have only been 11 cases of symptomatic OVP reported in the current literature.
Case report:
Our patient, a 62-year-old male presented with lateral foot pain following an inversion injury of his right foot, with no history of any previous trauma. What was initially mistaken as an avulsion fracture of the 5th metacarpal base was later revealed to be an OVP on contralateral X-ray.
Conclusion:
Treatment is mostly conservative, but surgical excision can be done in cases following failed non-operative treatment. In the context of trauma, OVP must be differentiated from other causes of lateral foot pain such as Iselin's disease and avulsion fractures of base of 5th metatarsal. Understanding the various etiologies of the condition and what those etiologies are usually related to can help prevent unnecessary treatment.
... Anatomic variations are common in the foot and ankle, including accessory ossicle, bipartition and coalition [1]. The reported incidence of the most common accessory ossicles of the foot in descending order is accessory navicular (11.7%), os peroneum (4.7%), os trigonum (2.3%), os supranaviculare (1.6%), os supratalare (0.2%), and os intermetatarseum (0.2%) [2]. ...
... Similar to other accessory ossicles in the foot, OVP is typically asymptomatic and found incidentally on routine radiographs or after an acute injury to the foot [6]. However, in a few reported cases, it can be the cause of lateral foot pain [1]. Even though OVP is described as bilateral by some authors [6], a review study including more than 1500 bilateral foot radiographs did not find any case with bilateral os vesalianum pedis [7]. ...
Os vesalianum pedis is a rare accessory foot ossicle, which is located proximal to the base of the fifth metatarsal bone. This anatomic variant is usually asymptomatic and detected incidentally on routine foot radiographs. However, it can be an infrequent cause of lateral foot pain and rarely become symptomatic following traumatic injuries to the ankle or foot. To date, there are few reported cases of symptomatic os vesalianum pedis described in the literature and most of them were treated surgically. We report a case of symptomatic os vesalianum pedis in a young adult female, which was misdiagnosed initially and managed conservatively with physiotherapy. Patient's symptoms regressed completely after a few sessions of physiotherapy and didn't require surgical intervention. We intended to publish this case to increase the awareness of this rare entity among radiologists and clinicians.
... They are considered to be developmental anomalies with almost 40 having been described [1,2]. The prevalence of accessory bones of the foot vary considerably from one author to the other, depending on the population investigated and imaging method, ranging between 21% to 49,2% [3,4]. The first large studies about these structures came out from cadaveric dissection [2,5,6]. ...
... The first large studies about these structures came out from cadaveric dissection [2,5,6]. After the discovery of x-rays, many studies were performed with radiological imaging [3,4,7,8]. Trolle performed a remarkable histoembryological study [7]. Throughout the literature we can find a rather uniform definition for accessory bones, that includes inconstant, well-corticated bones with a size of more than 1-2 mm and a regular shape in typical locations [1,2,7]. ...
... They are more frequent during the embryonal period and their frequency diminishes during further development for most of them [1]. Trolle believed that the presence of an accessory bone preformed in cartilage or duplicated in other species, indicates that the bone has probably phylogenetic origin [3]. On the other hand, multiple accessory bones are seen near the joints of the foot and along ligamentous insertions. ...
... Figura 2. Presencia y ausencia de los tipos de os trigonum de Punta Azul y La Guancha de los astrágalos derechos e izquierdos. , 1931;Case, Jones y Offenbecker, 2017;Cilli y Akçaoğlu, 2005;Coskun et al., 2009;Fu et al., 2019;Kalbouneh et al., 2019;Knapik et al., 2017;Peace et al., 2004;Sewell, 1904;Silva, 2011;Thomson, 1890;Tsuruta et al., 1981;Zwiers et al., 2018). ...
El os trigonum es un osículo que normalmente aparece durante la infancia y normalmente se fusiona a la parte posterior del astrágalo alrededor de la edad de 8-11 años. En ocasiones, puede haber una interrupción en el proceso de fusión usualmente por microtraumatismos. Una actividad intensiva del tobillo puede causar este grado de trauma necesario para interrumpir el proceso de desarrollo del astrágalo. Por lo tanto, este rasgo no-métrico puede proporcionar información importante sobre la infancia de poblaciones del pasado. Los astrágalos bien conservados de la cueva funeraria de Punta Azul y el yacimiento funerario de La Guancha-El Agujero, ambos localizados en las islas Canarias, han permitido estudiar el os trigonum para indagar más en la infancia de poblaciones de aborígenes canarios. La muestra de este estudio consistió en 149 astrágalos procedentes del yacimiento de Punta Azul (El Hierro) y 51 astrágalos de La Guancha-El Agujero (Gran Canaria), de entre los cuales se descartaron aquellos que presentaban daños postmortem. Los resultados evidencian que hay diferencias significativas de os trigonum entre las muestras estudiadas y las frecuencias son considerablemente altas comparadas con otros estudios similares. Se interpreta que la alta presencia del rasgo en las dos muestras estudiadas indica que los niños y niñas de las comunidades prehispánicas eran sujetos activos para la sociedad desempeñando, en menor o mayor medida, determinadas actividades socioeconómicas que requerían cierta sobrecarga física.
The os trigonum is an oscicle that normally appears during infancy and usually fuses to the posterior part of the talus bone around the age of 8 to 11 years of age. Occasionally, there can be interruptions in the developmental process due to microtrauma. An intensive ankle activity can cause this level of trauma to interrupt the developmental process of the talus. Therefore, this non-metric trait can provide important information about childhood in past populations. The well preserved tali of the funerary sites of Punta Azul and La Guancha-El Agujero that are located in the Canary Islands provide the opportunity to improve our understanding on aboriginal Canarian childhood. The sample used in this study consisted of 149 tali from Punta Azul (El Hierro) and 51 tali from La Guancha-El Agujero (Gran Canaria), excluding the tali that were badly preserved due to post-mortem damage. The results show statistically significant differences between the two samples included in this study and the results also show a high frequency of os trigonum among our sample compared to previous studies on other populations around the world. This high frequency is interpreted as an indication that aboriginal Canarian children were highly active individuals and highlights their role that required high physical exertion in pre-Hispanic Canarian society. El astrágalo como un indicador para el estudio de la infancia en las poblaciones prehispánicas de las islas Canarias
... Accessory ossicles are fused or unfused, and primary or secondary ossifications appear as well-corticated smooth bones. [1][2][3][4][5] An accessory navicular is one of the most ossicles in the foot. The accessory navicular has a reported prevalence of ~ 4 -21% and is the second most common ossicle in the foot. ...
... [12] The prevalence of accessory navicular bone varies from 4-21%. [17] This ossicle was found in 11.7% of Turkish population [1] and 21.3% of Japanese population. Koo et al. [18] reported that the incidence of the accessory navicular was 23% on conventional radiography, but 33% on digital tomosynthesis in a Korean population. ...
Background: Accessory navicular bone is one of the most common ossicles in the foot. Its prevalence is widely variable. These bones involve various mid-foot pathologies because of wide anatomic variations. It can cause medial foot pain, flattening the medial longitudinal arch, and impingement syndromes. The reported prevalence of accessory navicular is 4-21%. Objective: This study aimed to estimate the prevalence, anatomical variants, and distribution of accessory navicular bone of the foot in the radiograph by gender in the Indian population. Materials and methods: A retrospective study of 2068 radiographs of the foot (anteroposterior and oblique view) was performed. Used descriptive statistics for data analysis to know the prevalence of Accessory navicular bone. Results: 2068 radiographs were examined, in which 67.9 % of male and 32.1 % of female patients. In our study, the prevalence of accessory navicular is 16%, in which Type I (5.3%), Type II (9.1 %), and Type III (1.6%). Conclusion: Knowledge of accessory navicular of the foot helps avoid the common pitfall in clinical practice.
