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02 9744 2666
02 9580 6066

RANDWICK

CONCORD

HURSTVILLE

PENRITH

BELLA VISTA

CANBERRA

02 9399 5333

02 9744 2666

02 9580 6066

02 4721 7799

02 9744 2666

02 9580 6066
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Orthosports Question for Physiotherapist

Accessory Bones of the Foot and Ankle

Welcome to Question for Physiotherapists, April, 2022

This month Dr John Negrine discusses accessory bones of the foot and ankle.

Please feel free to send your questions to education@orthosports.com.au

Dr John Negrine
Dr John Negrine

Accessory ossicles around the foot and ankle are common skeletal variations. They are usually derived from the failure of union of secondary ossification centers adjacent to the main bone. They might be either adjacent to the main bone or separated.

They are of significance because they are frequently confused with fractures. Most are asymptomatic but occasionally following an injury the accessory ossicle may become symptomatic.

They often have interesting Latin names and identification and naming of them really impresses the patients most of whom have been told they have a fracture!

In the last few months I have taken three examples from my patients to illustrate the point.

Case 1: The first patient was a 16-year-old girl who injured her foot playing netball.
  • She presented with pain and tenderness at the base of the fifth metatarsal and was diagnosed as a fracture.
  • Her x-rays however show a rounded ossicle at the base of the fifth metatarsal.
  • This is an accessory bone known as the “os vesalainum” named after/by Andreas Vesalius the 16th century anatomist (recall that xray was not invented till 1895.)
  • The ossicle is a failure of ossification of the apophysis (growth plate in traction) and is in the fibres of peroneus brevis. It will usually ossify by age 14 in females.
X-ray - rounded ossicle at the base of the fifth metatarsal.

Case 2: A 40-year-old lady injured her ankle and has ongoing pain laterally.
  • Plain x-rays show a? Fracture of the anterior process of the calcaneus.
  • On MRI scan she has an accessory ossicle known as the “os calcaneus secundarius”.
MRI: os calcaneus secundarius
Case 3: A 32-year-old lady injured her ankle and presents with pain on the medial border of the foot.
  • Plain x-rays and an MRI scan clearly show an accessory navicular bone which is the site of her tenderness.
  • Interestingly the accessory ossicle is better imaged on plain x-ray than MRI scan.
Plain X-ray
MRI Scan
Management:
  • Initial management for all these patients consisted of resting in a walking boot.
  • When not settling, excision of the accessory bone and usually repair of the adjacent tendon into the bone is the treatment of choice.
Dr John Negrine
CONCORD 9744 2666 | HURSTVILLE 9580 6066 | PENRITH 4721 7799 | RANDWICK 9399 5333 | BELLA VISTA 9744 2666 | CANBERRA 9580 6066
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