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Case Reports
. 2023 Jun;13(6):74-78.
doi: 10.13107/jocr.2023.v13.i06.3702.

Red Herring in Orthopedics: A Case Report on Painful Os Vesalianum Pedis Masquerading as an Avulsion Fracture of 5th Metatarsal and Review of Literature

Ashish Jacob Mathew  1 , Clint Hugh  1 , Sanjay Nath  1 , Manju G Pillai  1
Affiliations
Case Reports

Red Herring in Orthopedics: A Case Report on Painful Os Vesalianum Pedis Masquerading as an Avulsion Fracture of 5th Metatarsal and Review of Literature

Ashish Jacob Mathew et al. J Orthop Case Rep. 2023 Jun.

Abstract

Introduction: Os vesalianum pedis (OVP) is a rare accessory ossicle of the foot located proximal to the base of 5th metatarsal. It is usually asymptomatic but can mimic an avulsion fracture of proximal 5th metatarsal and is an infrequent cause of lateral foot pain. There have only been 11 cases of symptomatic OVP reported in the current literature.

Case report: Our patient, a 62-year-old male presented with lateral foot pain following an inversion injury of his right foot, with no history of any previous trauma. What was initially mistaken as an avulsion fracture of the 5th metacarpal base was later revealed to be an OVP on contralateral X-ray.

Conclusion: Treatment is mostly conservative, but surgical excision can be done in cases following failed non-operative treatment. In the context of trauma, OVP must be differentiated from other causes of lateral foot pain such as Iselin's disease and avulsion fractures of base of 5th metatarsal. Understanding the various etiologies of the condition and what those etiologies are usually related to can help prevent unnecessary treatment.

Keywords: 5th metatarsal avulsion fracture; Os vesalianum pedis; foot ossicles; lateral foot pain.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Radiograph of the right foot (anteroposterior and oblique views) taken from another clinic immediately after the injury occurred where the patient was diagnosed as having sustained an avulsion fracture of the base of 5th metatarsal with an undisplaced fracture of distal phalanx of right big toe.
Figure 2
Figure 2
Radiograph of right foot (anteroposterior, lateral, and oblique views) taken in our hospital on the patient’s initial visit which revealed an accessory ossicle.
Figure 3
Figure 3
Radiograph of contralateral left foot (anteroposterior, lateral and oblique views) taken on clinical suspicion of Os Vesalianum Pedis which revealed accessory ossicle on the left foot too.
Figure 4
Figure 4
Radiograph of right foot (anteroposterior, lateral and oblique views) taken on follow up visit 4 weeks after initial injury to the foot.
See this image and copyright information in PMC

References

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