M. Sobel et al., PAINFUL OS-PERONEUM SYNDROME - A SPECTRUM OF CONDITIONS RESPONSIBLE FOR PLANTAR LATERAL FOOT PAIN, Foot & ankle international, 15(3), 1994, pp. 112-124
Plantar lateral foot pain may be caused by various entities and the pa
inful os peroneum syndrome (a term coined by the authors) should be in
cluded in the differential diagnosis. Painful os peroneum syndrome res
ults from a spectrum of conditions that includes one or more of the fo
llowing: (1) an acute os peroneum fracture or a diastasis of a multipa
rtite os peroneum, either of which may result in a discontinuity of th
e peroneus longus tendon; (2) chronic (healing or healed) os peroneum
fracture or diastasis of a multipartite os peroneum with callus format
ion, either of which results in a stenosing peroneus longus tenosynovi
tis; (3) attrition or partial rupture of the peroneus longus tendon, p
roximal or distal to the os peroneum; (4) frank rupture of the peroneu
s longus tendon with discontinuity proximal or distal to the os perone
um; and/or (5) the presence of a gigantic peroneal tubercle on the lat
eral aspect of the calcaneus which entraps the peroneus longus tendon
and/or the os peroneum during tendon excursion. Familiarity with the v
arious clinical and radiographic findings and the spectrum of conditio
ns represented by the painful os peroneum syndrome can prevent prolong
ed undiagnosed plantar lateral foot pain. Clinical diagnosis of the pa
inful os peroneum syndrome can be facilitated by the single stance hee
l rise and varus inversion stress test as well as by resisted plantarf
lexion of the first ray, which can localize tenderness along the dista
l course of the peroneus longus tendon at the cuboid tunnel. Radiograp
hic diagnosis should include an oblique radiograph of the foot for vis
ualization of the os peroneum and, if indicated, other imaging studies
. Recommended treatment ranges from conservative cast immobilization t
o surgical approaches including: (1) excision of the os peroneum and r
epair of the peroneus longus tendon, and (2) excision of the os perone
um and degenerated peroneus longus tendon with tenodesis of the remain
ing remnant of peroneus longus to the peroneus brevis tendon.