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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
Reference