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Accessory ossicles of the foot—an imaging conundrum

  • Shuyi GuoEmail author
  • Yet Yen Yan
  • Sonia Shu Yi Lee
  • Tien Jin Tan
Pictorial Essay
  • 35 Downloads

Abstract

Various anatomical variations can be found in the foot and ankle, including sesamoid bones and accessory ossicles. These are usually incidental findings and remain asymptomatic; however, they may cause complications resulting in painful syndromes or degenerative changes secondary to overuse or trauma. They can also lead to fractures or simulate fractures. These complications are challenging to diagnose on radiographs. Advanced imaging with US, CT, MRI, or Tc-99m bone scan is useful for definitive diagnosis. This study aims to illustrate how imaging modalities can be used to diagnose complications of common sesamoids and accessory ossicles of the ankle and foot (hallux sesamoids, os trigonum, accessory navicular, os supranaviculare, os peroneum, os intermetatarseum, and os calcaneus secundarius) and demonstrate the imaging differences between fractures and their mimics.

Keywords

Sesamoids Accessory ossicles Radiography Ultrasound Computed tomography Magnetic resonance imaging 

Notes

Authors’ contributions

All authors have made substantial contributions to the conception and design of the study, or acquisition of data, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, and final approval of the version to be submitted.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Mellado JM, Ramos A, Salvado E et al (2003) Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis. Eur Radiol 13(Suppl. 6):L164–L177CrossRefGoogle Scholar
  2. 2.
    Sarin VK, Erickson GM, Giori NJ, Bergman AG, Carter DR (1999) Coincident development of sesamoid bones and clues to their evolution. Anat Rec 257(5):174–180CrossRefGoogle Scholar
  3. 3.
    Nwawka OK, Hayashi D, Diaz LE, Goud AR, Arndt WF, Roemer FW, Malguria N, Guermazi A (2013) Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Insights Imaging 4(5):581–593CrossRefGoogle Scholar
  4. 4.
    Miller TT (2002) Painful accessory bones of the foot. Semin Musculoskelet Radiol 6(2):153–161CrossRefGoogle Scholar
  5. 5.
    Wong GNL, Tan TJ (2016) MR imaging as a problem solving tool in posterior ankle pain: a review. Eur J Radiol 85(12):2238–2256CrossRefGoogle Scholar
  6. 6.
    Abourazzak FE, Shimi M, Azzouzi H, Mansouri S, El Mrini A, Harzy T (2015) An unusual cause of medial foot pain: the cornuate navicular. Eur J Rheumatol 2(1):33–34CrossRefGoogle Scholar
  7. 7.
    Yalawar RS, Bhuyan D, Desai RS, Goswami G (2014) A rare case of symptomatic os supranaviculare in a sportsman. IOSR J Appl Phys 6(4):15–17CrossRefGoogle Scholar
  8. 8.
    Oh SJ, Kim YH, Kim SK, Kim M-W (2012) Painful os peroneum syndrome presenting as lateral plantar foot pain. Ann Rehabil Med 36(1):163–166CrossRefGoogle Scholar
  9. 9.
    Chagas-Neto FA, de Souza BNC, Nogueira-Barbosa MH (2016) Painful os peroneum syndrome: underdiagnosed condition in the lateral midfoot pain. Case Rep Radiol 2016:8739362Google Scholar
  10. 10.
    Henderson RS (1963) Os intermetatarseum and a possible relationship to hallux valgus. J Bone Joint Surg Br 45B(1):117–121CrossRefGoogle Scholar
  11. 11.
    Lawson JP (1994) International skeletal society lecture in honor of Howard D. Dorfman. Clinically significant radiologic anatomic variants of the skeleton. Am J Roentgenol 163(2):249–255CrossRefGoogle Scholar
  12. 12.
    Krapf D, Krapf S, Wyss C (2015) Calcaneus secundarius – a relevant differential diagnosis in ankle pain: a case report and review of the literature. J Med Case Rep 9:127CrossRefGoogle Scholar
  13. 13.
    Yan YY, Mehta KV, Tan TJ (2016) Fracture of the os trigonum: a report of two cases and review of the literature. Foot Ankle Surg 22(4):e21–e24CrossRefGoogle Scholar
  14. 14.
    Karadaglis D, Grace D (2003) Morphology of the hallux sesamoids. Foot Ankle Surg 9(3):165–167CrossRefGoogle Scholar
  15. 15.
    Biedert R, Hintermann B (2003) Stress fractures of the medial great toe sesamoids in athletes. Foot Ankle Int 24(2):137–141CrossRefGoogle Scholar
  16. 16.
    Boike A, Schnirring-Judge M, McMillin S (2001) Sesamoid disorders of the first metatarsophalangeal joint. Clin Podiatr Med Surg 28(2):269–285CrossRefGoogle Scholar
  17. 17.
    Kose O, Okan AN, Durakbasa MO, Emrem K, Islam NC (2006) Fracture of the os trigonum: a case report. J Orthop Surg (Hong Kong) 14(3):354–356CrossRefGoogle Scholar
  18. 18.
    Escobedo EM, MacDonald TL, Hunter JC (2006) Acute fracture of the os trigonum. Emerg Radiol 13(3):139–141CrossRefGoogle Scholar
  19. 19.
    Karasick D, Schweitzer ME (1996) The os trigonum syndrome: imaging features. Am J Roentgenol 166(1):125–129CrossRefGoogle Scholar
  20. 20.
    Pesquer L, Guillo S, Meyer P, Hauger O (2014) US in ankle impingement syndrome. J Ultrasound 17(2):89–97 PMC. Web. 22 Oct. 2018CrossRefGoogle Scholar
  21. 21.
    Miller TT, Staron RB, Feldman F, Parisien M, Glucksman WJ, Gandolfo LH (1995) The symptomatic accessory tarsal navicular bone: assessment with MR imaging. Radiology 195(3):849–853CrossRefGoogle Scholar
  22. 22.
    Mosel LD, Kat E, Voyvodic F (2004) Imaging of the symptomatic type II accessory navicular bone. Australas Radiol 48(2):267–271CrossRefGoogle Scholar
  23. 23.
    Chuang Y-W, Tsai W-S, Chen K-H, Hsu H-C (2012) Clinical use of high-resolution ultrasonography for the diagnosis of type II accessory navicular bone. Am J Phys Med Rehab 91(2):177–181CrossRefGoogle Scholar
  24. 24.
    Ingalls J, Wissman R (2011) The os supranaviculare and navicular stress fractures. Skelet Radiol 40(7):937–941CrossRefGoogle Scholar
  25. 25.
    Bianchi S, Bortolotto C, Draghi F (2017) Os peroneum imaging: normal appearance and pathological findings. Insights Imaging 8(1):59–68CrossRefGoogle Scholar
  26. 26.
    McLenna MK, Margolis M (1991) Radiology rounds. Can Fam Physician 37:1372–1375Google Scholar
  27. 27.
    Strayer SM, Reece SG, Petrizzi MJ (1999) Fractures of the proximal fifth metatarsal. Am Fam Physician 59(9):2516–2522Google Scholar
  28. 28.
    Hodge JC (1999) Anterior process fracture or calcaneus secundarius: a case report. J Emerg Med 17(2):305–309CrossRefGoogle Scholar
  29. 29.
    Ersen O, Akyıldız F, Ozyurek S, Sivrioglu AK (2013) Os calcaneus secundarius mimicking fracture. BMJ Case Rep 2013:bcr2013009954CrossRefGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyChangi General HospitalSingaporeSingapore

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