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    • #16542
      Xue Heng

      Hi, Steve.
      This was a 29-year-old male, with later ankle pain for several weeks.
      There was no history of trauma, over use or inversion.
      On US, coarse calcification was observed on the later ankle, with peripheral hypervascularity on Color Doppler.
      I have no idear where is the location of the calcification, and its relationship with terderness.
      I stored 2 clips so that it may be more easier to understand its spacial relationship.
      The second clip was got from the plantar side.
      It seems the calcification was inside the peroneal longus tendon, is this Calcified Tendinosis?
      Thank you very much, Steve!

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    • #16563
      Stephen Bird

      Hi Xue,

      This is a nice case,

      The calcification that you are looking at is indeed within the petronius longus tendon as it wraps around the cuboid bone changing its direction to pass under the foot to insert onto the base of the 1st MT and the medial cuneiform.

      This calcification is a normal variant and is known as the os peroneum.

      In your case there is a localised tendinosis associated with this part of the peroneus lonus tendon and while this normal variant can most often be asymptomatic it certainly can be the catalyst for a local tendinosis event as it is in your case.

      Personally I think if the calcification is beautiful and round with smooth borders it is usually asymptomatic, however when it is irregular like your example it is more likely to cause symptoms.

      Lovely case mate,


    • #16573
      Xue Heng

      Steve, what you say cleared up my confusions. Thanks again.
      Is it the similar process with accessory navicular to posterior tibialis tendon?
      Is there any other Accessory bones that would potentially be the catalyst for tendinosis?

    • #16588
      Stephen Bird

      Yes, it is a similar process,

      This process occurs where a tendon is in a high compression environment.

      In this situation the collagens converted to fibrocartilage as a process names sesamoid fibrocartilage transformation.

      When you palpate the tib post or peroneus longus tendons in these locations on a protection you will discover that it feels firm.

      The os perineum or os navicular (os tibial external) is just the next stage of this process where rather than collagen transforming to fibrocartilage it transform to a bony accessory ossicle.

      You also wee sesamoid fibrocartilage transformation in other areas such as the deep fibres of the Achilles where it is adjacent to the calcaneum.

      Once the accessory ossicle forms it may then become a catalyst for tendinosis and in the case of tib post with the os tibial external its it is a large ossicle (type 2) it will be forced to make a synchondrosis between the ossicle and the navicular. This can become a traction point and inflammation may develop.

      It is fascinating really !


    • #16605
      Xue Heng

      Thank you for drawing inferences about other cases from one instance.
      You are indeed a great teacher, Steve!

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