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Year : 2021  |  Volume : 5  |  Issue : 1  |  Page : 77-78

A speck of a bone

Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India

Date of Submission30-Dec-2020
Date of Decision11-Jan-2021
Date of Acceptance13-Jan-2021
Date of Web Publication20-Feb-2021

Correspondence Address:
Dr. Ganesh S Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmsr.jmsr_142_20

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How to cite this article:
Dharmshaktu GS. A speck of a bone. J Musculoskelet Surg Res 2021;5:77-8

How to cite this URL:
Dharmshaktu GS. A speck of a bone. J Musculoskelet Surg Res [serial online] 2021 [cited 2021 Feb 25];5:77-8. Available from: https://www.journalmsr.com/text.asp?2021/5/1/77/309929

  History Top

A 32-year-old male with a history of a blunt injury to his left foot was advised to have a radiographic examination of the foot, which was reported as no underlying bony injury.

  What are your findings? Top

On careful examination, one particular speck of an ossicle was noted medial to the base of the great toe corresponding to the metatarsocuneiform joint [Figure 1]. The radiograph of the opposite foot confirmed the bilateral presence of the ossicle at an identical site [Figure 2] on a magnified view.
Figure 1: An oblique radiographic view of the left (a) and right (b) foot showing an ossicle at identical sites on the medial aspect of the first cuneometatarsal joint

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Figure 2: The magnified portion of the image showing bilateral presence of the rare “os cuneometatarsale I tibiale” in the left (a) and right (b) foot

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  What is your diagnosis? Top

Os cuneometatarsale I tibiale

  Pearls and Discussion Top

The rare accessory bone at the bilateral medial aspect of the first metatarso-cuneiform joint, mostly an incidental finding, is termed “os cuneometatarsale I tibiale.”[1] Os cuneo-I metatarsale-I plantare is another accessory bone that may mimic cuneometatrsale I tibiale but can be easily differentiated by its location at the plantar surface of the first metatarsocuneiform joint. There are many accessory bones described within the human foot and some of these are more common and well recognized, like accessory navicular, os trigonum, or os vesalianum.[2] Os cuneometatarsale I tibiale has not been routinely described in prevalence studies regarding human accessory bones.[2] The clinical significance of these ossicles is not known due to extreme rarity of their existence. However, these ossicles might occasionally be misdiagnosed with fractures or avulsion injuries by novice practitioners. Acknowledgement and recognition of rare anomalous ossicles are important for proper documentation and further studies.

Declaration of patient consent

The author certifies that he has obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

There are no conflicts of interest.

  Further Reading Top

  • Coughlin MJ. Surgery of the foot and ankle in sesamoid and accessory bones of the foot. In: Mann's surgery of the foot and ankle. Vol. 2. Philadelphia: Sanders/Elsevier; 2006. p. 430-94.
  • Coskun N, Yuksel M, Cevener M, Arican RY, Ozdemir H, Bircan O, et al. Incidence of accessory ossicles and sesamoid bones in the feet: a radiographic study of the Turkish subjects. Surg Radiol Anat. 2009;31:19-24.

  References Top

Keles-Celik N, Kose O, Sekerci R, Aytac G, Turan A, Güler F. Accessory Ossicles of the Foot and Ankle: Disorders and a Review of the Literature. Cureus. 2017;9:e1881.  Back to cited text no. 1
Rowe SM, Lee KB, Park YB, Bae BH, Kang KD Sesamoids and Accessory Bones of the Forefoot in Normal Korean Adults. J Korean Foot Ankle Soc. 2005;9:20-5.  Back to cited text no. 2


  [Figure 1], [Figure 2]


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