Clinical aspects and epidemiology of os peroneum: a meta-analysis

Os peroneum (OP) is one of the most common accessory bones in the human foot. The literature indicates that its prevalence varies significantly and ranges between 0.4 and 20.3%. In the clinical context, OP is the main factor responsible for the pain condition known as os peroneum syndrome, which usually manifests as pain in the lateral side of the foot. The purpose of this study is to provide a comprehensive synthesis of data regarding the prevalence of this ossicle. To find the pertinent articles, a thorough search of the major electronic bases was carried out. Data on imaging modality, sex distribution, prevalence, and geographic origin of OP were extracted. Throughout the study, the PRISMA guidelines were strictly followed. The AQUA tool was used to evaluate the reliability of the included studies. 26 studies (22,948 feet) were included in the meta-analysis. The pooled prevalence estimate (PPE) of OP was found to be 6.6% (95% CI: 5.1-8.5) (95% PI: 0.02-0.22) of the analyzed feet. In the X-ray-based subgroup, the PPE of OP was 6.7% (95% CI: 5.1-8.7) and in the cadaveric dissection-based subgroup was 11.1% (95% CI: 5.1-22.4). The highest prevalence of OP was observed in North America (8.6% (95% CI: 5.9-12.3)), followed by Europe (6.0%, (95% CI: 3.8-9.4)) and Asia (5.9% (95% CI: 3.9-9.0)). Os peroneum is a very common accessory ossicle which occurs approximately every fifteen feet. The highest prevalence of OP was found in the North American population. The occurrence of pain in the lateral part of the foot should draw physicians attention into considering a potential presence of OP during the differential diagnosis.