Citation, DOI and article data. Sambhaji, C. Peroneal tubercle. Reference article, Radiopaedia. Classifications , Anatomy. Peroneal trochleas Peroneal trochlea Peroneal tubercles. URL of Article. Related pathology peroneal tubercle hypertrophy. Lui TH. Endoscopic Resection of Peroneal Tubercle. Related articles: Anatomy: Lower limb. We used preoperative MRI and dynamic ultrasonographic images as a diagnostic tool.
With these findings, we only addressed HPT resection without OP removal and achieved a successful result. Stockton reported four cases of HPT and OP resection followed by peroneus longus tenodesis to peroneus brevis. They mentioned that all had either enlarged OP or fracture. Pierson reported one case of HPT resection with OP enucleation, and the defect within the peroneus longus tendon was closed. OP resection potentially requires tenodesis of the peroneus longus tendon to the peroneus brevis tendon or tendon graft to restore its function, particularly when OP is too large to preserve the continuity of the peroneal longus tendon on its removal [ 20 , 21 ].
Recovery can require a long duration, with weeks of limited weight-bearing [ 21 ]. In the present case, the patient was able to achieve a quick recovery to a regular living with minimum physical or social restriction owing to being free from OP resection. Preoperative MRI and dynamic ultrasonographic imaging could be effective tools for identifying specific pain lesions.
The authors declare that there are no conflicts of interest regarding the publication of this manuscript. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles.
Journal overview. Academic Editor: Werner Kolb. Received 19 Nov Accepted 28 Dec Published 08 Jan Abstract Hypertrophic peroneal tubercle HPT is an overgrowth of the peroneal tubercle located on the lateral aspect of the hindfoot, which could cause tenosynovitis of the peroneus longus tendon. Introduction Hypertrophic peroneal tubercle HPT , an overgrowth of the peroneal tubercle, may cause a stenosing tenosynovitis of the peroneal tendon on the lateral hindfoot and require surgical treatment [ 1 ].
Case Presentation A year-old man reported pain in the lateral aspect of his right hindfoot during ambulation for 6 years. Figure 1. A bony protrusion had been palpitated on the lateral aspect of hindfoot red arrow. Figure 2. CT: Axial image a , sagittal image b , coronal image c , and 3D image d. Hypertrophic peroneal tubercle, a bony overgrowth surrounding a peroneal tendon red arrow.
Os peroneum, an ossicle on the outer anterior side of the calcaneus yellow arrow. Figure 3. Low-intensity lesion on T1-weighted image and high-intensity lesion on STIR image were detected around hypertrophic peroneal tubercle, and bone marrow lesions were suggested red arrow. Figure 4. Dynamic ultrasonographic image confirmed hypertrophic peroneal tubercle and os peroneum causing impacts.
Lidocaine injection was performed in between and os peroneum white arrow. Figure 5. Intraoperative photograph: a peroneus longus tendon runs through hypertrophic peroneal tubercle. A traction of peroneus longus tendon causes hypertrophic peroneal tubercle and os peroneum to collide with each other.
Hypertrophic peroneal tubercle, os peroneum. Figure 6. Two bony projections or protuberances may be seen from the lateral wall of the calcaneus — the peroneal tubercle and the retrotrochlear eminence. The peroneal tubercle is present immediately inferior to the fibular malleolus, lying in between the two tendons, it separates the tendons of peroneus brevis and the peroneus longus.
The common synovial sheath that covers the two tendons proximal to the tubercle divides into two slips to individually enclose the peroneal tendons at the tubercle and beyond. The peroneus brevis lies superior to the tubercle, and the peroneus longus lies inferior to the tubercle. The retrotrochlear eminence is located posterior to the peroneal tubercle and the peroneal tendons. It is seen to be prominent in individuals with hypertrophied peroneus quartus muscle , the most frequently reported accessory peroneal muscle.
The muscle arises from the inferolateral aspect of the fibula and has variable insertions, one of them being the retrotrochlear eminence. Some consider the height of the peroneal tubercle of 5 mm or more being a cutoff for diagnosis of hypertrophic peroneal tubercle 2. The initial management of the condition when symptomatic is conservative, but surgical resection is indicated in those who do not respond to conservative management.
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