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Accessory Ossicles, Ankle and Foot
Corrie M. Yablon, MD; Julia R. Crim, MD; Donna G. Blankenbaker, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Accessory ossicle: unfused ossification center; occurs at known, typical locations
            • Sesamoid: ossicle arising within tendon, improving tendon's mechanical advantage
            • Synchondrosis: cartilage bridge between ossicle and parent bone

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      • Nuclear Medicine Findings

                        DIFFERENTIAL DIAGNOSIS

                          CLINICAL ISSUES

                          • Presentation

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  • Reporting Tips

                                    Selected References

                                    1. Chan BY et al: Os conundrum: identifying symptomatic sesamoids and accessory ossicles of the foot. AJR Am J Roentgenol. 213(2):417-26, 2019
                                    2. Guo S et al: Accessory ossicles of the foot-an imaging conundrum. Emerg Radiol. 26(4):465-78, 2019
                                    3. Hennings R et al: Os calcaneus secundarius, a relevant differential diagnosis to fracture or pseudarthrosis of processus anterior of the calcaneus: a CT morphologic description. Surg Radiol Anat. 41(12):1425-32, 2019
                                    4. Schick F et al: Spontaneous fracture of the os peroneum with rupture of the peroneus longus tendon. J Foot Ankle Surg. 57(4):790-3, 2018
                                    5. Cohen BE: Hallux sesamoid disorders. Foot Ankle Clin. 14(1):91-104, 2009
                                    6. Nakasa T et al: Painful os intermetatarseum in athletes: report of four cases and review of the literature. Arch Orthop Trauma Surg. 127(4):261-4, 2007
                                    7. Chao W: Os trigonum. Foot Ankle Clin. 9(4):787-96, vii, 2004
                                    8. Ugolini PA et al: The accessory navicular. Foot Ankle Clin. 9(1):165-80, 2004
                                    9. Kono T et al: Symptomatic os subfibulare caused by accessory ossification: a case report. Clin Orthop Relat Res. (399):197-200, 2002
                                    10. Hodge JC: Anterior process fracture or calcaneus secundarius: a case report. J Emerg Med. 17(2):305-9, 1999
                                    11. Maffulli N et al: Traumatic lesions of some accessory bones of the foot in sports activity. J Am Podiatr Med Assoc. 80(2):86-90, 1990
                                    12. Ogden JA et al: Accessory ossification patterns and injuries of the malleoli. J Pediatr Orthop. 10(3):306-16, 1990
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Definitions

                                              • Accessory ossicle: unfused ossification center; occurs at known, typical locations
                                              • Sesamoid: ossicle arising within tendon, improving tendon's mechanical advantage
                                              • Synchondrosis: cartilage bridge between ossicle and parent bone

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Imaging Recommendations

                                                        • Nuclear Medicine Findings

                                                          DIFFERENTIAL DIAGNOSIS

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  • Image Interpretation Pearls

                                                                    • Reporting Tips

                                                                      Selected References

                                                                      1. Chan BY et al: Os conundrum: identifying symptomatic sesamoids and accessory ossicles of the foot. AJR Am J Roentgenol. 213(2):417-26, 2019
                                                                      2. Guo S et al: Accessory ossicles of the foot-an imaging conundrum. Emerg Radiol. 26(4):465-78, 2019
                                                                      3. Hennings R et al: Os calcaneus secundarius, a relevant differential diagnosis to fracture or pseudarthrosis of processus anterior of the calcaneus: a CT morphologic description. Surg Radiol Anat. 41(12):1425-32, 2019
                                                                      4. Schick F et al: Spontaneous fracture of the os peroneum with rupture of the peroneus longus tendon. J Foot Ankle Surg. 57(4):790-3, 2018
                                                                      5. Cohen BE: Hallux sesamoid disorders. Foot Ankle Clin. 14(1):91-104, 2009
                                                                      6. Nakasa T et al: Painful os intermetatarseum in athletes: report of four cases and review of the literature. Arch Orthop Trauma Surg. 127(4):261-4, 2007
                                                                      7. Chao W: Os trigonum. Foot Ankle Clin. 9(4):787-96, vii, 2004
                                                                      8. Ugolini PA et al: The accessory navicular. Foot Ankle Clin. 9(1):165-80, 2004
                                                                      9. Kono T et al: Symptomatic os subfibulare caused by accessory ossification: a case report. Clin Orthop Relat Res. (399):197-200, 2002
                                                                      10. Hodge JC: Anterior process fracture or calcaneus secundarius: a case report. J Emerg Med. 17(2):305-9, 1999
                                                                      11. Maffulli N et al: Traumatic lesions of some accessory bones of the foot in sports activity. J Am Podiatr Med Assoc. 80(2):86-90, 1990
                                                                      12. Ogden JA et al: Accessory ossification patterns and injuries of the malleoli. J Pediatr Orthop. 10(3):306-16, 1990