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os peroneum

Posted by michelle on 5/22/03 at 07:58 (119598)

have you dealt with os peroneum before and if you did how do you fix it? for 6 months and I am not getting better with physical therapy or a cotisone shot it all seems to make it hurt more. I stand on my feet 9hrs a day, and the swelling is really bad. please let me know what you think

Re: os peroneum

Ed Davis, DPM on 5/22/03 at 09:33 (119624)

Michelle:

Occasionally, it is necessary to remove the accessory bone although most patients find rapid relief with orthotics in my experience. It is critical that the orthotics be posted (wedged) correctly.
Ed

Re: os peroneum

Dr. David S. Wander on 5/23/03 at 18:34 (119771)

Ed,

Several years ago(1994) I had a paper published in the Journal of Foot & Ankle Surgery regarding surgial repair of a fractured multi-partite (many pieces) os peroneum and tear of the peroneus longus and brevis tendons. It is important to determine whether the origin of the pain is at the interface of the bone and tendon, or the interface between the accessory bone and the underlying bone. In addition to orthoses, an MRI is very useful to determine whether there is a fracture of the accessory bone or partial tear of the peroneus tendon. If there is no tear, an injection of local anesthetic and cortisone is often very useful. This must be done with care, since the cortisone has the potential to weaken the tendon and possibly contribute to a rupture. Therefore, if an injection is given, I would strongly advise some form of immobilization for several days.

Re: os peroneum

Ed Davis, DPM on 5/23/03 at 23:03 (119788)

David:

I have found that a significant number of MRIs come back noting a 'longitudinal' tear of peroneus longus below the level of the malleoli.
That area often does not correspond to the area of pathology and I question whether that is a normal variant. What are your thoughts on that?

If the area of pain is between the accessory bone and underlying bone, that tends to push the decision closer to surgery and I often avoid injecting in such situations. A number of patients have forefoot valgus with a supinatory rock but without significant pathology -- that group does better with orthotics. I am using diagnostic ultrasound in my office, occasionally for the first look, but use MRI if I am concerned that the pathology is significant.

Ed