Calcification at base of 5th MT in 11yr old female

[Sean Williams]

Hi Steve had an 11yr old girl present after a calcification was seen on X-ray adjacent to the base of the Lt 5th MT. The focus seemed to be in the insertion of the peroneous breves tendon. It was mildly swollen and tender but not particularly hyperaemic. Similar lesion was seen Rt side (not Xrayed)
I thought it might be something like an os peroneum until I watched your foot and ankle talk. Any thoughts on what it might be.

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[Stephen Bird]

Hi Sean,

It was great working with you and the rest of the team at Focus Radiology on the weekend.

It is a first class crew you are working with.

Nice images and a great diagnostic dilemma.

In adults I always think pain at the 5th metatarsal base is easy to sort out.
If they have had recent trauma it is a Jones fracture, or bone stress following the injury.
If there is no trauma it is usually lateral band of plantar fascia plantar fasciitis. Occasionally it may be 5th TMT arthritis.

But kids are another thing all together as they still have a growth plate!

To me that looks like a normal apophysis, which runs parallel to the metatarsal base ( fractures run transversely).
They can be avulsed, and develop traction apophysitis as a response to stress reaction, but would have soft tissue swelling / edema associated which is not evident here.
A bone scan or MR might be helpful if it’s a diagnostic dilemma.

So it is normal sonographically and on the plain radiograph , but if tender may represent some traction apophysitis.

Steve.

[Sean Williams]

Awesome, thanks Steve makes sense, will keep an eye out to see if they take it further

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