Skeletal Radiology

, Volume 34, Issue 7, pp 381–388 | Cite as

Cuboid oedema due to peroneus longus tendinopathy: a report of four cases

Scientific Article



To highlight focal bone abnormality in the cuboid due to tendinopathy of the adjacent peroneus longus.


A retrospective review was carried out of the relevant clinical and imaging features.


Two male and two female patients were studied, mean age 51.5 years (range 32―67 years), referred with foot pain and imaging showing an abnormal cuboid thought to represent either tumour or infection.


A long history of foot pain was usual with a maximum of 8 years. Radiographs were normal in two cases and showed erosion in two, one of which exhibited periosteal new bone formation affecting the cuboid. Bone scintigraphy was undertaken in two patients, both of whom showed increased uptake of isotope. MRI, performed in all patients, showed oedema in the cuboid adjacent to the peroneus longus tendon. The tendon and/or paratendinous tissues were abnormal in all cases, but no tendon discontinuity was identified. One patient possessed an os peroneum. Unequivocal evidence of bone erosion was seen using MRI in three patients, but with greater clarity in two cases using CT. Additional findings of tenosynovitis of tibialis posterior, oedema in the adjacent medial malleolus and synovitis of multiple joints in the foot were seen in one patient. Imaging diagnosis was made in all cases avoiding bone biopsy, but surgical exploration of the peroneal tendons was performed in two cases and biopsy of ankle synovium in one.


Oedema with erosion of the cuboid bone, simulating a bone lesion (cuboid “pseudotumour”), may be caused by adjacent tendinopathy of peroneus longus. It is vital to be aware of this entity to avoid unnecessary biopsy of the cuboid.


Cuboid Pseudotumour Peroneus longus Tendinopathy MRI 


  1. 1.
    Dombek M, Lamm B, Saltrick K, Mendicino R, Catanzariti A. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg 2003; 42:250―258.CrossRefPubMedGoogle Scholar
  2. 2.
    Rademaker J, Rosenberg Z, Delfaut E, Cheung Y, Schweitzer M. Tear of the peroneus longus tendon: MR imaging features in nine patients. Radiology 2000; 214:700―704.PubMedGoogle Scholar
  3. 3.
    Khoury N, El-Khoury G, Saltzman C, Kathol M. Peroneus longus and brevis tears: MR imaging evaluation. Radiology 1996; 200:833―841.Google Scholar
  4. 4.
    Weishaupt D, Schweitzer M. MR imaging of the foot and ankle: patterns of bone marrow signal abnormalities. Eur Radiol 2002; 12:416―426.CrossRefPubMedGoogle Scholar
  5. 5.
    Morrison W, Carrino J, Schweitzer M, Sanders T, Raiken D, Johnson C. Subtendinous bone marrow edema patterns on MR images of the ankle: association with symptoms and tendinopathy. AJR Am J Roentgenol 2001; 176:1149―54.PubMedGoogle Scholar
  6. 6.
    Boles M, Lomasney L, Demos T, Sage R. Enlarged peroneal process with peroneus longus tendon entrapment. Skeletal Radiol 1997; 26:313―315.CrossRefPubMedGoogle Scholar
  7. 7.
    Burman M. Subcutaneous tear of the tendon of the peroneus longus. Arch Surg 1956; 73:216―219.Google Scholar
  8. 8.
    Peacock K, Resnick E, Thoder J. Fracture of the os peroneum with rupture of the peroneus longus tendon: a case report and review of the literature. Clin Orthop 1986; 202:223―226.PubMedGoogle Scholar
  9. 9.
    Mains D, Sullivan R. Fracture of the os peroneum: a case report. J Bone Joint Surg Am 1973; 55:1529―30.PubMedGoogle Scholar
  10. 10.
    Sammarco G. Peroneus longus tendon tears: acute and chronic. Foot Ankle Int 1995; 16:245―253.PubMedGoogle Scholar
  11. 11.
    Burman M. Stenosing tenovaginitis of the foot and ankle. Arch Surg 1953; 67:686–698.Google Scholar
  12. 12.
    Saxena A, Pham B. Longitudinal peroneal tendon tears. J Foot Ankle Surg 1997; 36:173―179.PubMedGoogle Scholar
  13. 13.
    Sobel M, Geppert M, Hannafin J, Bohne W, Arnoczky S. Microvascular anatomy of the peroneal tendons. J Foot Ankle Surg 1992; 13:469―472.Google Scholar
  14. 14.
    Petersen W, Bobka T, Stein V, Tillmann B. Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand 2000; 71:168―174.CrossRefPubMedGoogle Scholar
  15. 15.
    Benjamin M, Ralphs J. Tendons and ligaments: an overview. Histol Histopathol 1997; 12:1135―1144.PubMedGoogle Scholar
  16. 16.
    Benjamin M, McGonagle D. The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J Anat 2001; 199:503―526.CrossRefPubMedGoogle Scholar
  17. 17.
    Benjamin M, Ralphs J, Newell R, Evans E. Loss of the fibrocartilaginous lining of the intertubercular sulcus associated with rupture of the tendon of the long head of biceps brachii. J Anat 1992; 182:281―285.Google Scholar
  18. 18.
    Benjamin M, Qin S, Ralphs J. Fibrocartilage associated with human tendons and their pulleys. J Anat 1995; 187:625―633.PubMedGoogle Scholar
  19. 19.
    McGonagle D, Benjamin M, Marzo-Ortega H, Emery P. Advances in the understanding of entheseal inflammation. Curr Rheumatol 2002; 4:500―506.Google Scholar
  20. 20.
    Cooper M, Selesnick F, Murphy B. Partial peroneus longus tendon rupture in professional basketball players: a report of two cases. Am J Orthop 2002; 31:691―694.PubMedGoogle Scholar
  21. 21.
    Salmons S, ed. Muscle. In: Bannister L, Berry M, Collins P, et al, eds. Gray’s anatomy, 38th edn. New York: Churchill Livingstone, 1995:889.Google Scholar
  22. 22.
    Sobel M, Pavlov H, Geppert M, Thompson F, DiCarlo E, Davis W. Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Foot Ankle Int 1994; 15:112―124.PubMedGoogle Scholar
  23. 23.
    Saxena A, Cassidy A. Peroneal tendon injuries: an evaluation of 49 tears in 41 patients. J Foot Ankle Surg 2003; 42:215―220.PubMedGoogle Scholar

Copyright information

© ISS 2005

Authors and Affiliations

  1. 1.Department of RadiologyRoyal National Orthopaedic Hospital NHS TrustStanmoreUK

Personalised recommendations