IS Case 221: Fracture of the os peroneum

Trushar Sarang, MD

Imaging Sciences URMC 2006
Publication Date: 2009-06-25


Patient is a 51-year-old male status post-football injury with 5th metatarsal and heel pain.


Fracture of the os peroneum.

Figures 1 & 2: The os peroneum on the lateral aspect of the cuboid is fractured with irregular cortical margins along the fracture line.


Fracture of the os peroneum


The os peroneum is one of the most common ossicles in the foot, presenting approximately 26% of the time. The ossicle resides within the fibers of the peroneus longus tendon as the tendon makes its turn around the cuboid before entering the canal formed by the long plantar ligament.

Fracture of this ossicle may result from violent dorsiflexion or direct impact from an external force. A fracture of this ossicle must be differentiated from a bipartite os peroneum, another normal variant. This can be done with correlation with history, palpation, and, MRI if necessary. Failure to diagnosis this condition may result in progressive tendinopathy caused by frictional forces of the bony fragments on the tendon and resultant chronic pain.

Treatment is generally conservative with casting and soft dressings. Surgery can be performed in refractory cases.


  1. Peterson JJ, Bancroft LW. Os peroneal fracture with associated peroneus longus tendinopathy. AJR Am J Roentgenol. 2001 Jul;177(1):257-8. [PMID: 11418450]
  2. Hogan JF. Fracture of the os peroneum. Case report and literature review. J Am Podiatr Med Assoc. 1989 Apr;79(4):201-4. [PMID: 2732921]
  3. Bessette BJ, Hodge JC. Diagnosis of the acute os peroneum fracture. Singapore Med J. 1998 Jul;39(7):326-7. [PMID: 9885696]

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