Search Results (7)

This report describes a unique constellation of accessory ossicles, highlighting their anatomical, clinical, and radiological significance. A 43-year-old female undergoing imaging for suspected fracture was evaluated using multi-detector computed tomography (MDCT) with 1.25 mm slice thickness. Multiplanar reconstructions (axial, coronal, sagittal) and three-dimensional volume-rendered images were analyzed. CT imaging revealed the coexistence of an os subfibulare and a tripartite os naviculare. Multiplanar and three-dimensional reconstructions confirmed the presence and configuration of variants. The combination of supernumerary bones and a multipartite ossicle represents an exceedingly uncommon anatomical presentation. This case illustrates an exceptional coexistence of multiple accessory ossicles, including an exceedingly rare tripartite os naviculare. Thorough radiological evaluation using MDCT and multiplanar reconstructions is essential for accurate identification and differentiation from fractures or other pathology. Full article

Flexor hallucis longus (FHL) tendon injuries, although rare, severely affect foot stability and mobility, particularly in individuals engaging in repetitive push-off actions. This case study examines a 27-year-old male who underwent surgical repair for FHL tendon rupture, followed by a structured, multi-modal rehabilitation program integrating advanced therapeutic techniques. The 12-week program was divided into three distinct phases to ensure a structured and progressive recovery process. The Early Phase (Weeks 1–4) focused on pain and edema control through interventions such as massage, electrotherapy, kinesiotaping, and the use of peritendinous ultrasonography to monitor recovery progress. The Intermediate Phase (Weeks 5–8) aimed to enhance strength and flexibility by incorporating Proprioceptive Neuromuscular Facilitation (PNF), weight-bearing exercises, dynamic stretching, and the progressive integration of Graston massage techniques. Finally, the Advanced Phase (Weeks 9–12) prioritized functional recovery, utilizing balance training, load transfer exercises, agility drills, and Theragun applications to prepare the individual for a return to optimal physical performance. Significant improvements were observed, including pain reduction (VAS score reduced by X%), increased dorsiflexion flexibility (from X° to X°), and enhanced muscle strength (e.g., tibialis anterior strength increased by X%). Functional assessments, such as the Y Balance Test, revealed improved endurance and mobility. This case study highlights the benefits of integrating innovative techniques like Graston massage and Theragun within a structured, evidence-based rehabilitation program to optimize recovery post-FHL tendon surgery. Full article

Background/Objectives: The anatomical variability of the human foot represents a subject of substantial interest, offering valuable insights in anthropological research as well as in clinical practice. The aim of this study is to document anatomical variants of the tarsal bones in a CISC//XXI skeletal sample (21st Century Identified Skeletal Collection), with a particular focus on the prevalence of accessory ossicles. Methods: The studied sample consisted of 163 individuals (83 females and 80 males). The prevalence of six accessory tarsal bones was recorded (os trigonum, calcaneum secundarium, the accessory navicular bone, os sustentaculum, os vesalianum and os intermetatarseum). Results: A total of 35 individuals (21.4%; 35/163) exhibited at least one accessory ossicle, with 13 females (15.7%; 13/83) and 22 males (27.5%; 22/80). The os trigonum and calcaneum secundarium were the most frequently observed accessory bones, respectively, in 9.3% (15/162) and 6.9% (11/159) of the individuals. No sex differences were observed. All accessory bones occurred more frequently unilaterally, and no co-occurrences of accessory bones were observed. Conclusions: These findings are crucial in both the biomedical and anthropological fields, where a detailed knowledge of foot anatomy and its variations is relevant. Full article

This case report describes a bipartite os trigonum fracture in a 21-year-old female patient following a pedestrian traffic accident. The os trigonum, a rare accessory bone located posterolaterally in the talus, can sometimes lead to painful symptoms. In this case, a fracture of the bipartite os trigonum was identified, along with an anterior talofibular ligament rupture. Radiologic examinations revealed both the bipartite variation of the os trigonum and the associated fracture, with diagnosis confirmed through computed tomography (CT) and magnetic resonance imaging (MRI). Treatment involved a short leg splint and joint range-of-motion exercises, resulting in symptom improvement and functional recovery. This case highlights the importance of recognizing the rare occurrence of os trigonum fractures, particularly the even rarer bipartite variant, and underscores the significance of CT and MRI in a detailed diagnosis. Full article

Background: Os trigonum (OT) is an accessory ossicle that develops from the failure of the secondary ossification center of the posterior talar process fusion. It is clinically significant due to its association with posterior ankle pain and impingement syndromes. Despite its tremendous clinical relevance, limited data exist on the frequency of OT in Middle Eastern populations. Objectives: This study aimed to determine the frequency, morphological variations, and dimensions of OT in Omani subjects using computed tomography (CT) imaging and to evaluate the sex and laterality differences in its occurrence. Methods: A retrospective cross-sectional study of 352 foot and ankle CT scans were conducted to assess the OT at Sultan Qaboos University Hospital. OT presence, dimensions, and classification along with patient demographics, including age and sex, were recorded. Descriptive statistical analysis and the chi-square test were employed to present the data. Results: The overall prevalence of OT was 10.2%, with a frequency of 11.2% on the left side and 8.9% on the right side. Type IIA was the most prevalent subtype in both feet (41.2% right, 44.4% left). The average minor-axis and macro-axis dimensions were 7.88 ± 2.998 mm and 10.76 ± 4.280 mm on the right side, while they were 8.06 ± 2.600 mm and 11.50 ± 4.997 mm on the left side. No statistically significant sex or laterality differences were observed with regard to the OT frequency (p > 0.05). Conclusions: This study provides the first detailed evaluation of OT in the Omani population, highlighting its frequency and morphological variability. These findings emphasize the importance of CT imaging in identifying OT and guiding clinical management. Future studies should explore OT’s clinical correlations to enhance its diagnostic and therapeutic implications. Full article

This study aimed to investigate the dimensions and types of the os trigonum and evaluate their relationship with various pathologic conditions on the posterior ankle using ankle MRI images. A total of 124 non-contrast-enhanced ankle and foot MR images of 123 consecutive patients were included in this retrospective study. The images were presented randomly, and they contained no patient information. The MR images were retrospectively and independently reviewed by two reviewers with a fellowship-trained musculoskeletal radiologist. The images were classified as type I and II based on the ossicle’s medial border overlying the talus’s posterior process and the groove for the flexor hallucis longus tendon (FHL). The study revealed that patients with type II os trigonum had a longer transverse diameter of the ossicle than type I, and there were statistically significant differences. Detachment status tended to be less in type I than in type II os trigonum, and the differences between the groups were statistically significant. There were no significant differences between type I and II os trigonum regarding posterior talofibular ligament (PTFL) abnormality, bone marrow edema, FHL tenosynovitis, and posterior synovitis. The study concluded that the os trigonum is a common cause of posterior ankle impingement, and type II os trigonum has a longer transverse diameter of the ossicle than type I. Full article

Background and Objectives: The incidence of accessory bones in the region of foot and ankle is quite variable between studies and are often confused with avulsion fractures in trauma patients with musculoskeletal injuries. The aim of this study was to assess the incidence of accessory ossicles of the foot and ankle according to gender, side and coexistence, and to determine how frequently accessory ossicles were misdiagnosed as avulsion fractures. Materials and Methods: Oblique and/or lateral foot radiographs of 1000 adult patients referred from emergency departments to foot and ankle clinic were retrospectively reviewed for the presence of accessory ossicles. The Kappa statistic was used in order to assess the validity of radiographic interpretation for the presence of these bones. Results: Accessory ossicles were detected in 40.2% of the radiographs. The incidence rates for the accessory ossicles in order of frequency were: Os trigonum (15.4%), accessory navicular (13.7%), os peroneum (11.5%), os vesalianum (1.1%), os supranaviculare (0.7%), os subfibulare (0.6%), os talotibiale (0.4%), os calcaneus secundarius (0.3%), os supratalare (0.3%), os infranaviculare (0.3%), os intermetatarseum (0.2%), and os subtibiale (0.1%). Coexistence of two or three ossicles in the same foot was observed in 4.4% of the cases, mostly coexistence with os peroneum (2.9%), followed by accessory navicular (1.6%). 2.7% of accessory ossicles were initially misdiagnosed as avulsion fractures at emergency departments. Interrater agreement over identification of different accessory ossicles was found to be reasonably reliable, with a Kappa greater than 0.80 for all assessed bones. Conclusions: In clinical practice, a thorough knowledge of normal anatomical variants is essential to facilitate appropriate diagnosis and treatment and can help to prevent diagnostic errors. Full article