yogabuch / pathology / painful os peroneum syndrome (POPS)

Definition of

If a peroneal bone is present, it can break or irritate the attachment tendon of the fibularis longus in the form of tendinitis, tendinosis, a partial rupture or a tear. The damage can occur as a result of acute trauma or as a chronic event. The size of the os peroneum also plays a role here.

Cause

1. Traumatic fracture or stress fracture of the os peroneum with rupture of the tendon of the fibularis longus and dislocation
2. Chronic condition due to improperly healed fracture of the peroneal bone with intact tendon
3. Os peroneum biparta or triparta with tendosynovitis of the insertion tendon of the fibularis longus
4. Prolonged exposure to pressure due to footwear
5. Osteonecrosis (avascular necrosis, AVN)
6. Entrapment of the insertion tendon of the fibularis longus between an oversized os peroneum and the os cuboideum

Predisposing

1. Presence of a peroneal bone

Diagnosis

1. Painful pressure over the peroneal bone and possibly along the insertion tendon of the fibularis longus
2. X-ray to detect the peroneal bone
3. Palpable protrusion if necessary
4. Sonography or MRI to detect tendon damage

Symptoms

1. possibly slight pain at rest
2. Pressure soreness
3. Lateral strain pain of the anterior tarsus

Complications

1. Rupture of the insertion of the fibularis longus

Therapy

1. Conservative as for tendinitis: immobilisation (plaster cast or orthosis for 4-6 weeks)
2. For rupture of the tendon: reconstruction
3. In the case of chronic POPS or an oversized os peroneum, this must be removed
4. Surgical intervention is more likely to be considered for competitive athletes