Bone membrane tear (periosteal avulsion)

(Perisotael avulsion)

The foot bones comprise the 7 tarsal bones (ossa tarsi), the 5 metatarsal bones (ossa metatarsi) and the 14 bones in the toes (phalanx). Muscles or ligaments are attached or anchored to all the bones. The outer surface of the bone is called bone membrane (periosteum), (Ultrasonic image).

Cause: A violent twist can stretch the ligaments and tear a small piece of bone membrane (periosteum) from the ligament anchor point. In other cases, bone membrane tears can occur when the bones impact upon each other (for example if the foot is bent or flexed backwards with great force so that one of the tarsal bones (talus) impacts against the front edge of the shin bone). Bone membrane tears in the ankle joint area are common, and can be seen in most cases where the person has played football for many years (“football-ankle”). Bone membrane tears can occur on all the bones of the foot where tendons or ligaments are anchored.

Symptoms: Pain when applying pressure, and when stretching the tendon or ligament which is attached to the bone.

Acute treatment: Click here.

Examination: Normal clinical examination is often sufficient. Larger tears can be seen on an x-ray. Many lesser tears can be best seen via an ultrasound (Ultrasonic image) scan or MRI examination, (article).

Treatment: Relief from the pain inducing activities. Larger tears can require surgical operation. Lesser tears do not require treatment. Some cases can cause prolonged discomfort with pain which does not recede despite relief. This can be due to the tear causing inflammation in the tissue. In such cases, rheumatic medicine (NSAID) or injection of corticosteroid in the area surrounding the tear can be recommended.

Rehabilitation: Rehabilitation is totally dependent upon the type of tear, and the treatment (conservative or surgical).
Also read rehabilitation, general.

Complications: If there is not a steady improvement in the condition consideration must be given as to whether the diagnosis is correct, or if complications have arisen: