Accessory ossicles of the foot and ankle are normal variants of bone development that usually remain asymptomatic. However, they may be involved in various disorders and become a source of pain such as in fractures, dislocations, degenerative changes, osteonecrosis, osteoarthritis, osteochondral lesions, avascular necrosis, and irritation or impingement of adjacent soft tissues. Hence, during the assessment of the situations above, knowledge about these little-known ossicles could be very important to reach the correct diagnosis. Recent studies in the literature have mostly focused on the most frequent 9-12 accessory bones. In this review, 24 types of accessory ossicle are described. These ossicles are accessory navicular bone, os peroneum, os trigonum, os intermetatarseum, os vesalianum. os subfibulare, os subtibiale, os calcaneus secundarius, os calcanei accessorium, os supratalare, os sustentaculi, os talotibiale, os tali accessorium, talus secundarius, os subcalcis, os cuboideum secundarium, os supranaviculare, os infranaviculare, os paracuneiforme, os intercuneiforme, os cuneometatarsale I tibiale, os cuneometatarsale plantare, os cuneo–I metatarsale-II dorsale, and os aponeurosis plantaris. The clinical importance of these bones should be known thoroughly to reduce unnecessary orthopedic consultations and misdiagnosis. This article describes the clinical importance of the accessory ossicles and their possible pathological conditions. Understanding the possible disorders of the accessory ossicles of the foot and ankle can provide a more accurate diagnostic process.

We examined the prevalence, symmetry pattern, age and gender differences in Turkish population. It is the first study performed on Turkish population with the largest sample in current literature. Prevalence of fabella is found to be 22.8% which is quite similar with other Caucasian ethnic populations.

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This study aims to document a detailed investigation on the sesamoid bones (SBs) of Turkish subjects from different parts of Turkey in a multi-center study, in both hands, according to gender, frequency and divisions of the bones' coexistence and bilaterality by radiography. Patients and methods: This retrospective and three-centered study was performed between June 2010 and April 2012. Sesamoid bones were examined by anteroposterior and oblique X-rays of 1,444 hands of 772 subjects (367 males, 405 females; mean age 42.7 years; range, 18 to 87 years). All X-rays were evaluated by at least two independent observers. In controversial circumstances, at least three observers together gave the final decision by consensus. Results: Metacarpophalengeal (MCP) joint of the thumb (MCP 1) had sesamoid in all subjects (100%) and it was seen bilaterally. The prevalence of the SB was 42.8% in the second MCP joint (MCP 2) in 772 subjects and 36.6% in 1,444 hands, 1.6% in the third MCP joint (MCP 3) for the subjects and 1.1% for the hands, 0.1% in the fourth MCP joint (MCP 4) for the subjects and 0.1% for the hands, and 72.5% in the fifth MCP joint (MCP 5) for the subjects and 62.5% for the hands. The prevalence of SB in the first interphalangeal joint (IP 1) was 21.8% and SB was detected in 18.6% of the hands. Sesamoid bones of the MCP 2, MCP 5, and IP 1 was recorded more frequently in females. Sesamoid bone of the same joints (MCP 2, MCP 5 and IP 1) was detected more frequently bilaterally than unilateral right side and more frequently unilaterally on right side than unilateral left side. Conclusion: The distribution of SBs varies according to hand regions, gender, and side. Having knowledge of the locations and the rate of bilaterality of SBs may assist clinicians in both clinical and radiological diagnoses.