Surgical Management of Painful Os Vesalianum: A Case Report and Literature Review

Accessory bones, such as the Os vesalianum, are developmental skeletal variations in the ankle and foot. The prevalence of Os vesalianum is between 0.1% and 1.0% of the population. It lies proximal to the fifth metatarsal base and is found within the peroneus brevis tendon.

We present a case of a 34-year-old female with persistent pain in the lateral border of her left foot. X-rays were suggestive of Os vesalianum. Computed tomography and magnetic resonance imaging confirmed a thin line of fluid between Os vesalianum and the fifth metatarsal base. After failed conservative measures, she was managed by surgical excision of the Os vesalianum and reattaching the peroneus brevis to the fifth metatarsal base with a suture anchor. The patient resumed routine activities 8 weeks later, with no residual pain. After 3 months of follow-up, the patient's strength was normal, and she had no pain.

Os vesalianum, though rare, is mostly asymptomatic and is often detected incidentally. In symptomatic cases, it can cause chronic lateral foot pain. It is important to differentiate Os vesalianum from other causes of chronic lateral foot pain, such as a Jones fracture or avulsion fracture. Surgical excision with peroneus tendon repair is the standard treatment, giving favorable outcomes in symptomatic cases that do not respond to conservative measures.