Knowing Your Accessory Foot Ossicles and Avoiding Misdiagnoses: A Case Report of Painful Os Vesalianum Pedis

Abstract

Os vesalianum pedis is located proximal to the base of the fifth metatarsal. Rarely, this accessory ossicle can be the source of lateral foot pain. There are very few cases of symptomatic os vesalianum pedis described in the literature, and most of them were surgically managed. We report a painful case of os vesalianum pedis managed conservatively. A 25-year-old professional soccer player presented with lateral left midfoot pain. There was no known acute sprain or trauma, and no history of injuries in the left lower limb. The athlete reported both mechanical and inflammatory pain findings and tenderness on the palpation of the fifth metatarsal base. We conducted a radiographic study of the left foot and found an image compatible with os vesalianum pedis. A right foot X-ray was also performed, and similar findings were reported, although the athlete had no pain. The athlete was treated conservatively, and the return-to-play was seven days.Due to the unspecific symptoms of our athlete, many diagnoses could be considered such as peroneus brevis tendinopathy, lateral plantar fasciitis, ligamentum plantare longum sprain. However, the X-ray findings led us to other possible pathologies, mainly affecting the bone. Integrating clinical and radiological findings is mandatory to achieve a proper diagnosis and avoid mistakenly diagnosing a fracture such as a Jones fracture or pseudo-Jones fracture. Even though os vesalianum pedis is usually asymptomatic, this condition can lead to chronic pain. Well-designed conservative management should always be pursued to treat this condition as it might prevent the need for surgery.

Fifth Distal Phalanx Avulsion Fracture in a High-Level Marathon Runner

“…The osseous anatomy and forces applied to the lateral column of the foot predispose the fifth ray to injuries [ 6 ]. Proper diagnosis and treatment are crucial for addressing these fractures and promoting a successful recovery [ 7 ].…”