Bilateral os cuneo-I metatarsale-I dorsale: a rare case in which serial imaging suggested a localized ossification disturbance.
Kenji Yokoyama, Tetsuya Matsuura, Nobutoshi Takamatsu et al.
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Case in brief
A 9-year-old boy, a competitive kendo practitioner, presented with bilateral os cuneo-I metatarsale-I dorsale, an exceptionally rare accessory bone. Longitudinal imaging over one year showed the progression from a superficial subchondral irregularity to a distinct ossified fragment. Surgical excision alleviated pain caused by mechanical impingement of the extensor hallucis longus tendon, leading to complete symptom resolution and return to sports.
What made this case unusual
The case highlights a longitudinal imaging perspective on the ossification disturbance associated with os cuneo-I metatarsale-I dorsale, which is rarely documented.
Diagnostic / clinical pearl
Clinicians should consider mechanical impingement of the extensor hallucis longus tendon as a potential source of pain in cases of os cuneo-I metatarsale-I dorsale, rather than relying solely on typical nerve entrapment associations.
Why it matters
This case emphasizes the importance of thorough physical examination to accurately identify the source of pain in patients with accessory bones, which can significantly influence management decisions.