De Castro Correia Miguel, Rodrigues Lopes Tiago
Physical Medicine and Rehabilitation, North Rehabilitation Center, Vila Nova de Gaia, PRT.
Cureus. 2022 Jul 27;14(7):e27380. doi: 10.7759/cureus.27380. eCollection 2022 Jul.
Os vesalianum pedisis 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 pedisdescribed 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 brevistendinopathy, lateral plantar fasciitis, ligamentum plantare longumsprain. 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.
跗副舟骨位于第五跖骨基部的近端。这种副骨很少会成为足外侧疼痛的根源。文献中描述的有症状的跗副舟骨病例非常少，且大多数都通过手术治疗。我们报告一例采用保守治疗的疼痛性跗副舟骨病例。一名25岁的职业足球运动员出现左足中足外侧疼痛。既往无已知的急性扭伤或外伤史，左下肢也无受伤史。该运动员自述既有机械性疼痛表现又有炎症性疼痛表现，且在触诊第五跖骨基部时有压痛。我们对其左脚进行了影像学检查，发现影像与跗副舟骨相符。还对其右脚进行了X线检查，尽管该运动员右脚并无疼痛，但也报告了类似的检查结果。该运动员接受了保守治疗，七天后恢复比赛。由于我们这位运动员的症状不具有特异性，可能会考虑多种诊断，如腓骨短肌腱病、足底外侧筋膜炎、足底长韧带扭伤等。然而，X线检查结果让我们考虑到了其他可能的病变，主要是影响骨骼的病变。综合临床和影像学检查结果对于做出正确诊断并避免误诊为琼斯骨折或假琼斯骨折等骨折至关重要。尽管跗副舟骨通常无症状，但这种情况可能会导致慢性疼痛。对于这种情况，应始终采用精心设计的保守治疗方法，因为这可能会避免手术的必要性。
