This Dr. Kevin Lam talking to you about os peroneum syndrome of the ankle.
We're gonna look at some x-rays of what os peroneum looks like on an x-ray,
it's very self-evident, and we'll go over a case.
This is os peroneum by the blue arrows as you can see a little piece of bone on the side of the
cuboid bone, that's an extra bone the people are born with.
Again, this is from another view, you see those little blue arrows that's -- people are born with that,
it's called os peroneum and can cause instability, pain, and burning.
This is a video talking about something called the os peroneum syndrome. Os peroneum syndrome is
an extra piece of bone within a tendon of the ankle, most of the time patients are gonna complain
about burning outside the ankle or feeling instability and pain and this can be very constant
going down into the bottom of the foot. And here's the reason why --
the tendon is called a peroneus longus tendon and that tendon goes from the -- this is the --
looking at the foot model, this the outside of your foot here, you know, looking at this that's the
outside of your foot, the fifth metatarsal is on this side. So one, two, three, four, five.
The os peroneum is embedded, it's usually in the tendon called the peroneus longus.
This is where the tendon runs underneath. It cogs around this cuboid bone, if I can show this on here,
cogs around this cuboid bone and wraps around to the bottom and goes into the foot and it attaches
and fans out and attaches to this area right about here, the first metatarsal base
as well as the medial cuneiform. So this tendon goes around from the ankle,
behind the ankle, behind the fibula and around the cuboid.
So a lot of times patients are gonna have pain right here about the cuboid area, right about this area
I can press and down here. That's usually the symptoms that we will see in patients
that complain about that. Some could be very nondescript but usually an x-ray like
we showed you before is gonna show that extra piece of bone called os peroneum.
Sometimes they're big, sometimes they're smaller, and that bone within a tendon
as it goes around the cuboid can tear the tendon itself -- it can tear the
peroneus longus tendon, that's why people become symptomatic.
Now I've heard a doctor tell a patient that you've had this since you were born
So why are you having symptoms now?
Well the reason why these patients have symptoms later on in life is if they twist the
foot the wrong way or they've sprained their ankle, that bone within the tendon
can cause a tear of the peroneus longus tendon. So imagine a rubber band, a tube
going around this bone and then you twist that ankle, there's also another piece of
bone inside the ankle which is the os peroneum inside the tendon and that can
cause the tear of the peroneus longus tendon.
So that's why when patients -- yes, you were born with this, os peroneum
is not something that just showed up all of a sudden but symptoms can show
all of a sudden after a traumatic event or chronic overuse syndrome.
And now the video that I'm gonna show towards the end of my discussion about
this is a very active 59 year old gentleman who's a runner who came in to me first
for a consultation for the same exact problem. He went for a second opinion
before the surgery and decided to come back for the other doctor did not give him any
kind of answers and the only answer the other doctor gave him was well, you were born with this,
I don't know why it's causing your symptoms right now. Now, again, it is true that you're born with it
and some people are asymptomatic until a traumatic event or chronic overuse syndrome
causes a tear in the peroneus longus tendon.
An MRI would give us a good indication if there's a tear or not.
But there is a -- a problem with the MRI that it cannot tell you longitudinal or tears on the long
axis of the tendon - the peroneus longus tendon as accurately as it can tell a tear transversely if
it goes across. That's why I always try to explain to my patients, we see swelling on the MRI,
we see any hint of a possible longitudinal tear, the best thing to do is if you continue to have pain and
you've tried physical therapy and bracing and modified activities and it still bothers you,
then it's time to surgically go in and take that piece of bone out, clean out the tendon and repair
the tendon. There's really no harm in doing that after you've been through conservative care and you
still have a significant amount of pain. I'll leave you with the video of the patient interview,
he's about a year post-op and running more and more now
that we have his os peroneum syndrome taken care of.
Two years ago subluxing and a tear,
peroneal tendon repair, the guy wasn't sure if the surgery would help him because -- but it's been
two years now. So, how are you doing? "I'm doing really good."
Keep on pressing against -- this is him going out towards me, you see the tenderness,
you can see the peroneal tendon right here. Keep a constant pressure on there.
The peroneal tendon is right here, it's staying behind the fibula now. This is the follow-up to my
other video about peroneal tendon subluxation and peroneal tendon tear.
Unfortunately this young man is -- he is a runner and he's had constant chronic pain right here
because peroneal tendon was actually torn along the fibula and subluxing or dislocating to the front.
So after some convincing of you know, that the surgery may help him, now it's years out
he does not have any pain and you're continuing to run and do activities, am I correct, sir?
Marathon training, yes. So now he's doing very good. Mileage is going back up again? "Yup."
Good. "Fifteen, sixteen, seventeen miles." Perfect, perfect sir. Let's bring it up this way.
Do that range of motion in the circle for me again. He's in excellent shape as you can see,
fine definition of his muscles, no more dislocation, ankle looks good, there's no more cracking,
keep on going right here, the incision is very fine right right behind the peroneal tendon
that's where I did the incision that we would hide it as well as allow for the repair of this
peroneal complex right here. I'm keeping it behind the bone so it's not popping out in front so you
won't get another tear again. Have you felt any instability on this ankle at all?
"I've got more stability than I had, I can run on uneven turf, I've never been able to do that."
"It's like my ankles wanted to roll. I had to be very careful."
Well, you're doing great now, because the tendon is not dislocating, you look like, you know,
after 2 years this is great, and do you have any suggestions for other people who have this kind of
problem and are afraid or uncertain if the surgery will help them?
"Don't delay, get it done, stay active."
100%, you know, don't go on a downward spiral. I mean, it looks great that tendon --
again, the peroneal tendon right here on this muscular guy here going from here to here
and it stays behind the fibula.
I mean, nothing complex here was done, I mean, just went ahead and deepened the groove a little
bit with the peroneal tendon, so make a nice little groove with the peroneal tendon inside the cup
and so that way when he moves now he's able to do his activities and get extra stability of the ankle.
"I was back running in 3 months."
You know, you're an excellent patient my man.
"Just do your therapy."
Therapy is obviously very important to help you increase strength and at this point man,
you're pretty much better than you were before surgery and you're -- off you go my man.
"Yes, very much so."