Presentation
Right foot trauma - suspected Lisfranc injury.
Patient Data
No evidence of fracture. Subcutaneous edema around the ankle and on the dorsum of the foot.
Bilateral accessory ossicle at base of the distal phalanx of the 1st toe 1, lateral plantar surface; the left one is in two pieces/members - probably bipartite ossicle, although fracture cannot entirely be ruled out. Arthritic changes at their interface with the distal phalanx.
Bilateral os intermetatarseum; the right one is fused with the anterior tip of the medial cuboid.
Bilateral os trigonum.
Right bipartite medial hallux sesamoid.
X-rays of the right foot done over a year later show the accessory ossicle at the base of the 1st distal phalanx, the os intermetatarseum (on frontal and lateral views), the os trigonum, and the bipartite medial hallux sesamoid.
Case Discussion
Incidentally discovered accessory ossicles and sesamoids of the ankle and forefoot, not to be mistaken for old fractures - in this case, the variant bones were bilateral but this is not always the case.
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