Session Title: Virtual Poster Hall
Session Time: None. Available on demand.
Disclosures: Carrie A. Miller, MD: No financial relationships or conflicts of interest
Case Description: A 40 year old male presented to a walk-in orthopedic injury clinic for evaluation of left foot pain. The foot pain started 2-3 weeks ago with no specific injury or trauma. Three months prior he started treadmill running 4 miles every other day. The foot pain is located on the lateral aspect of the foot. Initially, the pain was only present with running but is now present with walking. He reports a similar episode of pain in 2017 that resolved with 12 weeks in a post-op shoe. Exam of the left lower extremity is notable for tenderness over the base of the 5th metatarsal; no swelling. Sensation intact to light touch through the deep peroneal, superficial peroneal, sural, saphenous, and tibial distributions. 5/5 strength on testing of ankle dorsiflexion, ankle plantarflexion, inversion, eversion, extensor hallucis longus, and flexor hallucis longus. Radiographs of the left foot show an os vesalianum just proximal to the base of the 5th metatarsal versus an old non-united fracture at the base of the 5th metatarsal.
Setting: Walk-in orthopedic injury clinic
Patient: A 40 year old male recreational runner with left foot pain Assessment/
Results: The patient was placed in a tall walker boot and advised to weight-bear as tolerated. Three weeks later the patient was seen by a foot/ankle surgeon. The pain had decreased, and the patient transitioned out of the boot into orthotics.
Discussion: The differential diagnosis of pain near the base of the 5th metatarsal is broad and should include stress fracture, peroneus brevis tendinopathy, and a painful os vesalianum.
Conclusion: Os vesalianum is an uncommon accessory bone that is rare cause of foot pain. It can be difficult to distinguish from a fracture of the base of the 5th metatarsal on imaging. If non-operative management is unsuccessful, surgical excision should be considered.
Level of Evidence: Level V
To cite this abstract in AMA style:Miller CA, Simpson S. An Unusual Cause of Foot Pain in a Runner: A Case Report [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/an-unusual-cause-of-foot-pain-in-a-runner-a-case-report/. Accessed October 23, 2021.
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