Elsevier

Foot and Ankle Surgery

Volume 17, Issue 1, March 2011, Pages e10-e12
Foot and Ankle Surgery

Case report
Avulsion fracture of the peroneus longus tendon insertion at the base of the first metatarsal: Report of a case

https://doi.org/10.1016/j.fas.2010.07.004Get rights and content

Abstract

Isolated avulsion fracture of the peroneus longus tendon insertion at the base of the first metatarsal is very rare. Similar to most avulsion fractures that result from excessive strain at a tendon or ligament insertion, this type of injury is caused by the strong tension exerted by the peroneus longus tendon. The mechanisms leading to this lesion and treatment options are not clearly defined.

We present the case of an isolated minimally displaced intra-articular avulsion fracture at the plantar lateral base of the first metatarsal. Faced with a painful non-union following conservative treatment we considered excision of the bony fragment and first tarsometatarsal arthrodesis. This leads to a favourable functional outcome.

Introduction

Avulsion fracture of the peroneus longus (PL) tendon insertion at the base of the first metatarsal (M1) without injury of the tarsometatarsal (TMT) joint is very rare. In the literature only few cases have been described [1], [2], [3]. Nevertheless, the incidence of this lesion is probably underestimated because of the lack of specific symptoms and the difficulty to detect the fracture on standard radiographs. Correct diagnosis may therefore be delayed for several months and influence definitive treatment.

We propose a treatment option in case of non-union of this intra-articular injury.

Section snippets

Case report

A 35-year-old overweight woman sustained a combined eversion–dorsiflexion strain of her right foot when she was walking quickly on flagstones. Despite pain along M1 she was able to continue walking for three days before presenting to her family doctor. Swelling on the plantar aspect of the foot was noticed, there was also pain at simultaneous eversion of the foot, extension of the ankle, and extension of the first metatarsal. Plain X-rays were poorly contributive for diagnosis. Magnetic

Discussion

Anatomical variations in the insertion of the PL tendon have been recently well described in a cadaveric study by Patil et al. [4]. They found an additional insertion at the medial cuneiform in more than 85% of the cases and other insertions (neck of M1, base of M2, base of M4 and base of M5) in lesser percentages. The PL tendon everts and aids in plantar flexion of the foot at the ankle and is responsible for pulling the base of M1 inferiorly. It is also a stabilizer of both the longitudinal

Conflict of interest statement

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

No fund was received in support of this study.

Acknowledgements

There were no other contributors to this paper other than the listed authors and the subject (patient) themselves. No separate funding was used in the writing of this paper.

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    Isolated avulsion fracture at the plantar lateral base of the first metatarsal: a case report

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