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Accessory Bones of the Foot

most common accessory bones

less common accessory bones

  • os supratalare (antero-supero aspect of talus)
  • os supranaviculare (superior aspect of navicular - seen on lateral)
  • processus uncinatus (at intersection of navicula, 2nd and 3rd cuniform)
  • os intercuneiforme (between the 1st and 2nd cuniforms)
  • pars peronea metatarsalia (1st cuniform and 1st metatarsal)
  • cuboides secundarium (proximal-medial aspect of cuboid)
  • os talotibiale (anterior tibia)
  • os subcalcis (inferior aspect of calcaneus)
  • os sustentaculum
  • os intermetatarseum (between the 1st and second metatarsal)
  • os subfibulare:
    • historically, this has been considered to be an accessory ossicle located just below the ditsal fibular epiphysis;
      • it is distinguished from a fracture by its smooth borders, and by the fact that a fracture will preferentially involve the physis;
    • there is some recent evidence to suggest that this structure may represent a nonunion of an avulsion frx from the fibula;
      • these patients may demonstrate ipsilateral ankle instability and absence of a similar ossicle on the contra-lateral side of the foot;
    • reference:

Work Up of Suspected Painful Accessory Bone:

  • bone scan:
    • increased uptake on bone scan indicates that the lesion is probably symptomatic;
  • CT scan:
    • helps work up unusual accessory bones and the anatomical imaging will help explain how they are causing symptoms