Ankle pain may result from a variety of diseases.An underestimated cause of chronic lateral ankle pain is thepresence of a hypertrophic tuberculumperoneum(TP).As the differential diagnosis with more frequent causes of anklepainsolelybasedon clinical findingsis often impossible,imaging isvery useful for evaluation of the sizeofa TP and its effecton the surrounding structures.
The aim of thisexhibitistoreview the clinical and imaging features of symptomatic hypertrophic (TP)ina cohort ofsymptomatic patients.
TheTPis located on the lateral surface of the calcaneus,
anteriorlytotheeminentiaretrotrochlearis( Fig. 1 ).Anatomically,the TP has anobliquecourse frompostero-superior toantero-inferior.The peroneus...
Methods and Materials
Our study is amonocentric,
retrospectivecohortstudyof 23 patients.Inclusion criteria includedreferralfor imaging(either US,
CT or MRI;Table 1)for chronic lateral ankle pain below the lateral malleolus and a width of the tuberculumperoneum≥ 3 mm .
Patients with underlying fracture were excluded.
Conventional radiography was performed on the AXIOMLuminosdRF(Siemens,
lateral and Mortise view are the three standard images performed of the ankle.
Additional axial image to visualize the hypertrophic tuberculum was also performed.USimagesusingPhilips Health Systems EPIQ5G (Bothell,
CBCTimaging was performed...
Twenty three patients were included in our study,10men and13women.Eleven patients presented with right-sided chronic ankle pain while the left ankle was affected in 12 cases.
Ninepatients had a history of previous ankle distortion,
ranging between several months to yearspreceding clinicalpresentation.
In 4 patients the request form for imaging mentioned overuse.
One patient hadplanovalgusfoot deformity.
The mean width oftheTPin these symptomatic patients was5.6 mm(range3.6 - 8.6mm).Isolated tenosynovitisof theperoneus longus( Fig. 4 and Fig. 5 )wasseenin9cases(grade 1 n=6 and grade 2 n=3).Isolated tenosynovitis of the peroneus brevis(...
Hypertrophic tuberculumperoneumis an underestimated cause of chronic ankle pain following previous anklesprainand should be considered in the differential diagnosis of other causes of lateral ankle pain.
An advantage of US in comparison to the other modalities is the dynamic aspect of the examination along with the ability to correlate with the location of the pain of the patient.
The meanwidthof theTPin our series (5.6 mm) of symptomatic cases is larger thanin the literature (3.13mm).Auniform definition of hypertrophic TP is lacking but awidth of ≥ 5...
Review ofcommonand unusual causes of lateral ankle pain.
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E-mail of the authors for correspondence
The authorsare grateful toDanny Verreth for his artwork of Figure 1.