{"id":61742,"date":"2026-09-27T10:39:30","date_gmt":"2026-09-27T15:39:30","guid":{"rendered":"https:\/\/osteomag.ca\/?p=61742"},"modified":"2026-09-27T10:39:31","modified_gmt":"2026-09-27T15:39:31","slug":"painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain","status":"publish","type":"post","link":"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/","title":{"rendered":"Painful Os Peroneum Syndrome: A Rare Cause of Lateral Foot Pain"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_89 counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #000000;color:#000000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #000000;color:#000000\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 eztoc-toggle-hide-by-default' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#What_Is_the_Os_Peroneum\" >What Is the Os Peroneum?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#The_Role_of_the_Peroneus_Longus\" >The Role of the Peroneus Longus<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#What_Is_Painful_Os_Peroneum_Syndrome\" >What Is Painful Os Peroneum Syndrome?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#How_Can_a_Fracture_Occur\" >How Can a Fracture Occur?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#What_Are_the_Symptoms\" >What Are the Symptoms?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Differential_Diagnosis_Fifth-Metatarsal_Fracture\" >Differential Diagnosis: Fifth-Metatarsal Fracture<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Differential_Diagnosis_Peroneal_Tendinopathy\" >Differential Diagnosis: Peroneal Tendinopathy<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Differential_Diagnosis_Cuboid_Syndrome\" >Differential Diagnosis: Cuboid Syndrome<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Radiographs\" >Radiographs<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Ultrasound\" >Ultrasound<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#MRI\" >MRI<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Conservative_Treatment\" >Conservative Treatment<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#The_Role_of_Osteopathy\" >The Role of Osteopathy<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Peroneal_Strengthening\" >Peroneal Strengthening<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#The_Role_of_the_First_Ray\" >The Role of the First Ray<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#When_Is_Surgery_Considered\" >When Is Surgery Considered?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Why_Is_Diagnosis_Sometimes_Delayed\" >Why Is Diagnosis Sometimes Delayed?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#When_Should_the_Patient_Be_Referred\" >When Should the Patient Be Referred?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Retesting\" >Retesting<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-20\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#What_Osteopathy_Cannot_Claim\" >What Osteopathy Cannot Claim<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-21\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Conclusion\" >Conclusion<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-22\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Acute_Fracture_or_Normal_Multipartite_Ossicle\" >Acute Fracture or Normal Multipartite Ossicle?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-23\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#Why_Can_Pain_Occur_Without_a_Fracture\" >Why Can Pain Occur Without a Fracture?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-24\" href=\"https:\/\/osteomag.ca\/en\/painful-os-peroneum-syndrome-a-rare-cause-of-lateral-foot-pain\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n<p>Pain along the plantar-lateral border of the foot is often attributed to an ankle sprain, the cuboid, the peroneal tendons, or the fifth metatarsal. A rarer cause deserves recognition: <strong>painful os peroneum syndrome<\/strong>.<\/p>\n<p>The os peroneum is a small sesamoid bone located within the peroneus longus tendon near the cuboid. It is present in only part of the population and usually causes no symptoms. It becomes clinically important when fractured, separated, degenerative, or associated with injury to the peroneus longus tendon.<\/p>\n<p>The diagnosis can be missed because this region is not always examined specifically. For the osteopath, recognizing the syndrome helps avoid attributing persistent lateral foot pain to a simple \u201cblocked cuboid\u201d when a sesamoid fracture or tendon injury may be present.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"What_Is_the_Os_Peroneum\"><\/span>What Is the Os Peroneum?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The os peroneum is generally located within the peroneus longus tendon as the tendon curves around the lateral cuboid before crossing under the foot toward the base of the first metatarsal.<\/p>\n<p>It can be ossified, cartilaginous, single, or multipartite. It is often bilateral.<\/p>\n<p>Its presence is a normal anatomical variant, not a disease.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"The_Role_of_the_Peroneus_Longus\"><\/span>The Role of the Peroneus Longus<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The peroneus longus contributes to eversion and plantar flexion. Its tendon passes behind the lateral malleolus, descends along the calcaneus, and changes direction around the cuboid.<\/p>\n<p>This curve places substantial stress on the tendon during sport, propulsion, and sudden inversion movements.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"What_Is_Painful_Os_Peroneum_Syndrome\"><\/span>What Is Painful Os Peroneum Syndrome?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The term covers several conditions described in the literature [1]:<\/p>\n<ul>\n<li>acute fracture of the os peroneum;<\/li>\n<li>separation of a multipartite os peroneum;<\/li>\n<li>partial peroneus longus tendon tear;<\/li>\n<li>complete tendon rupture;<\/li>\n<li>stenosing tenosynovitis;<\/li>\n<li>impingement around a hypertrophied peroneal tubercle;<\/li>\n<li>degenerative change or rare osteonecrosis.<\/li>\n<\/ul>\n<p>The common feature is pain near the plantar-lateral cuboid region.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"How_Can_a_Fracture_Occur\"><\/span>How Can a Fracture Occur?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Forced inversion or supination can suddenly tension the peroneus longus. The os peroneum may fracture or fragments of a multipartite ossicle may separate.<\/p>\n<p>The tendon itself may also be injured.<\/p>\n<p>Acute pain can be confused with a lateral ankle sprain or fifth-metatarsal fracture.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"What_Are_the_Symptoms\"><\/span>What Are the Symptoms?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li>plantar-lateral midfoot pain;<\/li>\n<li>pain near the cuboid;<\/li>\n<li>pain with walking or push-off;<\/li>\n<li>tenderness along the peroneus longus;<\/li>\n<li>local swelling;<\/li>\n<li>pain with resisted eversion or plantar flexion;<\/li>\n<li>weakness or difficulty rising onto the forefoot.<\/li>\n<\/ul>\n<p>In chronic cases, pain may be more diffuse and activity related.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Differential_Diagnosis_Fifth-Metatarsal_Fracture\"><\/span>Differential Diagnosis: Fifth-Metatarsal Fracture<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>A fracture at the base of the fifth metatarsal produces more distal and usually very focal bony pain.<\/p>\n<p>The os peroneum is more proximal, near the calcaneocuboid region.<\/p>\n<p>Radiographs often help distinguish the two.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Differential_Diagnosis_Peroneal_Tendinopathy\"><\/span>Differential Diagnosis: Peroneal Tendinopathy<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Peroneus brevis or longus tendinopathy can cause pain behind the lateral malleolus or along the lateral foot.<\/p>\n<p>Painful os peroneum syndrome is often, in practice, a specific form of peroneus longus pathology.<\/p>\n<p>Ultrasound and MRI can determine whether the tendon is torn, thickened, or surrounded by fluid.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Differential_Diagnosis_Cuboid_Syndrome\"><\/span>Differential Diagnosis: Cuboid Syndrome<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The term \u201ccuboid syndrome\u201d is used for lateral midfoot pain presumed to relate to cuboid mechanics.<\/p>\n<p>Before attempting to manipulate the cuboid, fracture, tendon injury, and painful os peroneum syndrome should be excluded when significant trauma or pain is present.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Radiographs\"><\/span>Radiographs<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Radiographs can show the os peroneum and identify fracture or unusual separation of fragments.<\/p>\n<p>A normal multipartite ossicle generally has smooth, well-corticated, rounded borders. An acute fracture may show more irregular margins.<\/p>\n<p>Comparison with the opposite foot can sometimes help.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Ultrasound\"><\/span>Ultrasound<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Ultrasound is particularly useful because it can examine the peroneus longus dynamically.<\/p>\n<p>It may show:<\/p>\n<ul>\n<li>partial tendon tear;<\/li>\n<li>tenosynovitis;<\/li>\n<li>fragment displacement;<\/li>\n<li>irregularity around the os peroneum;<\/li>\n<li>dynamic impingement.<\/li>\n<\/ul>\n<p>Classic radiological work has described the association between os peroneum fractures and peroneus longus tendon injuries [1,2].<\/p>\n<h2><span class=\"ez-toc-section\" id=\"MRI\"><\/span>MRI<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>MRI evaluates the ossicle, bone marrow, tendon, and soft tissues at the same time.<\/p>\n<p>It is useful in chronic pain or when radiographs cannot distinguish a normal multipartite ossicle from a recent injury.<\/p>\n<p>A 2021 pictorial review reminds clinicians that accessory ossicles can become symptomatic through fracture, inflammation, necrosis, or injury to neighbouring tissues [3].<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Conservative_Treatment\"><\/span>Conservative Treatment<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>An injury without major tendon rupture can initially be managed with:<\/p>\n<ul>\n<li>relative rest;<\/li>\n<li>reduced running and jumping;<\/li>\n<li>appropriate footwear;<\/li>\n<li>temporary immobilization for some fractures;<\/li>\n<li>graded loading;<\/li>\n<li>calf and peroneal rehabilitation.<\/li>\n<\/ul>\n<p>The plan depends on imaging findings and tendon stability.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"The_Role_of_Osteopathy\"><\/span>The Role of Osteopathy<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>An osteopath can work on overall ankle and foot mobility, weight-bearing tolerance, and gradual return to movement.<\/p>\n<p>A region where fracture or tendon rupture is possible should not be manipulated aggressively.<\/p>\n<p>Acute pain after inversion with focal tenderness deserves a diagnosis first.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Peroneal_Strengthening\"><\/span>Peroneal Strengthening<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>After the painful phase, rehabilitation can include:<\/p>\n<ul>\n<li>band-resisted eversion;<\/li>\n<li>calf raises;<\/li>\n<li>single-leg balance;<\/li>\n<li>walking over varied surfaces;<\/li>\n<li>progression to running and changes of direction.<\/li>\n<\/ul>\n<p>The peroneus longus should regain enough capacity to control the foot during propulsion.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"The_Role_of_the_First_Ray\"><\/span>The Role of the First Ray<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The peroneus longus inserts near the base of the first metatarsal and medial cuneiform. It therefore contributes to dynamic forefoot stability.<\/p>\n<p>Tendon pain can alter propulsion and transfer load elsewhere.<\/p>\n<p>Rehabilitation should therefore address more than the local painful area.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"When_Is_Surgery_Considered\"><\/span>When Is Surgery Considered?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Surgery may be required with:<\/p>\n<ul>\n<li>complete peroneus longus rupture;<\/li>\n<li>displaced fracture;<\/li>\n<li>persistent pain despite conservative treatment;<\/li>\n<li>substantial mechanical impingement;<\/li>\n<li>symptomatic non-union.<\/li>\n<\/ul>\n<p>Options depend on the lesion and may include ossicle excision, tendon repair, fixation, or reconstruction.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Why_Is_Diagnosis_Sometimes_Delayed\"><\/span>Why Is Diagnosis Sometimes Delayed?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The condition is rare, the os peroneum is not present in everyone, and lateral foot pain has many possible causes.<\/p>\n<p>In addition, radiographs may show the ossicle without its significance being immediately recognized.<\/p>\n<p>Accurate diagnosis therefore requires correlation of imaging with the tendon course and symptoms.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"When_Should_the_Patient_Be_Referred\"><\/span>When Should the Patient Be Referred?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Medical assessment is appropriate when:<\/p>\n<ul>\n<li>pain follows significant trauma;<\/li>\n<li>weight bearing is difficult;<\/li>\n<li>eversion strength is reduced;<\/li>\n<li>pain remains focal near the cuboid;<\/li>\n<li>radiographs show a displaced fragment;<\/li>\n<li>symptoms persist for several weeks despite good care.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Retesting\"><\/span>Retesting<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Functional measures can include walking, calf raises, single-leg stance, and resisted eversion.<\/p>\n<p>Return to running should be gradual and assessed both during exercise and the following day.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"What_Osteopathy_Cannot_Claim\"><\/span>What Osteopathy Cannot Claim<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>It cannot \u201cput back\u201d a fractured os peroneum, repair a torn tendon, or reliably distinguish a multipartite ossicle from a fracture by palpation alone.<\/p>\n<p>It can support comfort, mobility, and functional return once important structural injury has been excluded.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Conclusion\"><\/span>Conclusion<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Painful os peroneum syndrome is a rare but important cause of plantar-lateral foot pain. It represents a spectrum involving both the ossicle and the peroneus longus tendon.<\/p>\n<p>Radiographs, ultrasound, and MRI may be needed to distinguish anatomical variation, fracture, and tendon injury.<\/p>\n<p>For the osteopath, the essential point is not to reduce this pain to a \u201cblocked cuboid.\u201d Persistent or traumatic pain along the outside of the foot deserves structural assessment before aggressive intervention.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Acute_Fracture_or_Normal_Multipartite_Ossicle\"><\/span>Acute Fracture or Normal Multipartite Ossicle?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>This distinction is one of the main radiological pitfalls. A multipartite os peroneum can naturally have several fragments. Smooth, well-corticated borders favour an old variant, whereas new separation, irregular edges, marked displacement, or adjacent edema suggest a recent injury.<\/p>\n<p>Comparison with the opposite foot and imaging of the peroneus longus can be particularly useful. Misinterpretation can lead either to unnecessary immobilization of a normal variant or failure to identify a tendon rupture.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Why_Can_Pain_Occur_Without_a_Fracture\"><\/span>Why Can Pain Occur Without a Fracture?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The peroneus longus changes direction sharply around the cuboid. Tenosynovitis, tendon thickening, or impingement against a prominent peroneal tubercle can irritate the os peroneum without a visible fracture. Chronic pain may therefore be mechanical and tendinous rather than purely bony.<\/p>\n<p>In these situations, dynamic ultrasound can be especially useful for observing the tendon during foot movement.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ol>\n<li>Sobel M, Pavlov H, Geppert MJ, et al. Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. <em>Foot Ankle Int<\/em>. 1994;15(3):112-124. PMID:7951939.<\/li>\n<li>Brigido MK, Fessell DP, Jacobson JA, et al. Radiography and US of os peroneum fractures and associated peroneal tendon injuries. <em>Radiology<\/em>. 2005;237:235-241.<\/li>\n<li>Kim HG, Choi HY, Park JS, et al. Clinical Features and Radiological Differential Diagnoses of Symptomatic Sesamoid Bones and Accessory Ossicles: A Pictorial Essay. <em>J Korean Soc Radiol<\/em>. 2021;82(1):82-98.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Persistent pain along the plantar-lateral foot can occasionally come from the os peroneum and peroneus longus tendon rather than a simple ankle sprain or \u201cblocked cuboid.\u201d<\/p>\n","protected":false},"author":1,"featured_media":61117,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"tdm_status":"","tdm_grid_status":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-61742","post","type-post","status-publish","format-standard","has-post-thumbnail","category-non-classifiee"],"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/posts\/61742","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/comments?post=61742"}],"version-history":[{"count":0,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/posts\/61742\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/media\/61117"}],"wp:attachment":[{"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/media?parent=61742"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/categories?post=61742"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/tags?post=61742"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}