CASO DA SEMANA Dr.Marcelo de Queiroz Pereira da Silva

Quadro clínico: Mulher de 42 anos com dor na face lateral do pé.

IMAGENS 1 a 3

Imagens 4, 5 e 6

IMAGENS 7 e 8

DESCRIÇÃO DAS IMAGENS: FIGURAS 1 A 3 : RM Sequência Coronal T2 Spir- Imagem de osso acessório na substância do tendão fibular longo, na altura do cuboide. O tendão demonstra sinal elevado e rupturas parciais acima do Os Peroneum, e edema inflamatório das partes moles adjacentes. FIGURAS 4 A 6: RM Sequência Axial T1- Os peroneum no interior do tendão fibular longo e espessamento dos tecidos moles locais junto ao cubóide. FIGURA 7:RM Sequência Sagital T2 Spir FIGURA 8:RM Sequência Sagital T1 Figuras 7 E 8: Demonstram a integridade do os peroneum, sem fraturas.

DIAGNÓSTICO ???

Síndrome de Atrito do OS Peroneum

Os Peroneum

Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Sobel M, Pavlov H, Geppert MJ, Thompson FM, DiCarlo EF, Davis WH. Sobel MPavlov HGeppert MJThompson FMDiCarlo EFDavis WH Source Orthopaedic Foot and Ankle Service, Beth Israel Medical Center-North Division, New York, New York. Abstract Plantar lateral foot pain may be caused by various entities and the painful os peroneum syndrome (a term coined by the authors) should be included in the differential diagnosis. Painful os peroneum syndrome results from a spectrum of conditions that includes one or more of the following: (1) an acute os peroneum fracture or a diastasis of a multipartite os peroneum, either of which may result in a discontinuity of the peroneus longus tendon; (2) chronic (healing or healed) os peroneum fracture or diastasis of a multipartite os peroneum with callus formation, either of which results in a stenosing peroneus longus tenosynovitis; (3) attrition or partial rupture of the peroneus longus tendon, proximal or distal to the os peroneum; (4) frank rupture of the peroneus longus tendon with discontinuity proximal or distal to the os peroneum; and/or (5) the presence of a gigantic peroneal tubercle on the lateral aspect of the calcaneus which entraps the peroneus longus tendon and/or the os peroneum during tendon excursion. Familiarity with the various clinical and radiographic findings and the spectrum of conditions represented by the painful os peroneum syndrome can prevent prolonged undiagnosed plantar lateral foot pain. Clinical diagnosis of the painful os peroneum syndrome can be facilitated by the single stance heel rise and varus inversion stress test as well as by resisted plantarflexion of the first ray, which can localize tenderness along the distal course of the peroneus longus tendon at the cuboid tunnel