Abstract
Objective:The aim of this article is to review the clinical and imaging features of symptomatic hypertrophic (TP) in a cohort of symptomatic patients.Materials and Methods:Twenty-three patients with chronic lateral ankle pain were retrospectively included in our study group. Patients underwent ultrasound (US), (cone beam) computed tomography (CB)CT or magnetic resonance (MR) examination or a combination of these examinations with a standardized protocol. Patients with an underlying fracture were excluded. The following parameters were recorded: clinical history, size of the TP on different imaging modalities, presence and grade of peroneus brevis/longus tenosynovitis and the presence of bone marrow edema at the os calcaneus on magnetic resonance imaging (MRI).Results:The mean width of the hypertrophic TP was 5.6 mm. Combined tenosynovitis of the peroneus longus (PL) and brevis tendon (PB) was most common, followed by isolated PL and finally PB tenosynovitis. Grade 1 tenosynovitis was most common. BME was present in 53% of the cases.Conclusion:The width of the TP is may be evaluated on the (oblique) coronal US, (CB)CT or non-fat suppressed MR images. Both US and MRI may detect and grade involvement of the peroneal tendons. By the use of fluid sensitive sequences, MRI may be of additional value to detect bone marrow edema as result of repetitive friction.
Highlights
Ankle pain may result from a variety of diseases
Isolated tenosynovitis of the peroneus brevis was present in only 4 patients
bone marrow edema (BME) is was solely visible on the Full thickness tear (FS) T2-Weighted Images (WI) images and was present in 53% (9 out of 17 patients)
Summary
An underestimated cause of chronic lateral ankle pain is the presence of a hypertrophic tuberculum peroneum (TP) [1]. As the differential diagnosis with more frequent causes of ankle pain solely based on clinical presentation is often impossible, imaging is very useful for evaluation of the size of a TP and its effect on the surrounding structures. The TP has an oblique course from posterosuperior to antero-inferior. The peroneus longus and brevis tendon run respectively under and above the TP, separating their tendon sheaths. It functions as fulcrum directing the peroneus longus tendon towards the cuboid. The inferior peroneal retinaculum inserts on the TP [2]
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