Symptomatic Ossicles

Question 1

What are the 2 most prominent areas of the medial aspect of teh foot?

Answer 1

prominence of navicular head and talar prominence

Question 2

what happens to talar prominence with STJ pronation?

Answer 2

prominence is exaggerated with STJ pronation

Question 3

what happens to talar prominence with STJ supination?

Answer 3

prominence is reduced with STJ supination

Question 4

what is the most common accessory ossicle?

Answer 4

the accessory navicular

*has 3 typical presentations

Question 5

at what age can navicular prominence be seen radiographically?

Answer 5

age 9-11

Question 6

what is the type 1 navicular prominence?

Answer 6

• small ossicle proximal to navicular tuberosity

- is classified as a true sesamoid bc it is within the tibialis posterior tendon

Question 7

what is the type 2 navicular prominence?

Answer 7

-true accessory scaphoid appears radiographically as an extension of the navicular (its connection to navicular is represented by a radiolucent zone

Question 8

what is type 3 navicular prominence?

Answer 8

represents a true carnuate navicular or enlarged navicular tuberosity
(may be type 2 with an osseous bridge)

Question 9

what is the conservative treatment for talar prominence?

Answer 9

-functional orthoses
-AFO
-shoe modification
-steroid injection
-steroids
NSAIDs

Question 10

what are some surgical options for treating talar prominence?

Answer 10

arthrodesis (fusion) of STJ, mid-tarsal joint (CC; Talonavicular) or all 3

Question 11

what is the conservative treatment for navicular prominences?

Answer 11

(very similar to talar prominences)

• immobilization, NSAIDs, NWB
• shoe modification
• AFO

Question 12

how would you do surgery for a type 1 navicular prominence?

Answer 12

-remove the ossicle from the tendon by using a tendon splitting approach or reflection of the tibialis posterior from the tn joint capsule & then removing the ossicle

Question 13

how would you do surgery for a type 2 navicular prominence?

Answer 13

• visualize the mass using imaging
• excision of the fragment
• may result in wekaening of tendon or capsule

Question 14

what position should i be in for surgery to type 3 neurological preference?

Answer 14

STJ supinated

Question 15

what is dorsal bossing?

Answer 15

(of the 1st tarso-metatarsal joint) is a common acquired disorder of the foot that leads to arthritic changes

Question 16

bony prominece at teh 1st met-cuneiform joint can be classified by types. what is type 1? etiology?

Answer 16

DORSAL exostosis formation located at 1st met-cuneiform joint
*etiology: FF valgus plantarflexed 1st ray

Question 17

bony prominece at teh 1st met-cuneiform joint can be classified by types. what is type 2? etiology?

Answer 17

exostosis located circumeferentially (dorsal, medial, and plantar)

• has an arthritic component also
• etiology: trauma, arthritis

Question 18

bony prominece at teh 1st met-cuneiform joint can be classified by types. what is type 3?

Answer 18

DORSAL exostosis of 1st met-cuneiform joint + angular malalignment
(1st met dorsiflexes, plantarflexes, adducts)

Question 19

bony prominece at teh 1st met-cuneiform joint can be classified by types. what is type 4?

Answer 19

dorsal exostosis + Lis Franc’s joint

Question 20

bony prominece at teh 1st met-cuneiform joint can be classified by types. what is type 5?

Answer 20

pseudo exostosis secondary to position (ex. pes cavus) that causes

Question 21

what is os vesalinium?

Answer 21

accessory bone located at the base of the 5th met

Question 22

where is os tibiale externum located?

Answer 22

on navicular tuberosity

Question 23

where is os peroneus found?

Answer 23

accessory bone located inferior to the peroneal groove of the cuboid
(encompassed within peroneus longus tendon)

Question 24

where is os trigonum found?

Answer 24

lateral process of the posterior aspect of teh talus

Question 25

when does os trigonum fues with talus usually?

Answer 25

age 18

Question 26

irritation of os trigonum is caused by which tendon?

Answer 26

flexor hallucis longus