Abstract
Heterotopic ossification (HO) is abnormal formation of mature lamellar bone in soft
tissues. HO is most commonly diagnosed in the setting of localized trauma, which results
in improper differentiation of progenitor cells, leading to aberrant tissue formation.
In the pediatric population, nongenetic causes of HO have rarely been reported, especially
HO involving the tendons of the ankle. We present a case of HO of the peroneus brevis
tendon without systemic disease in a pediatric patient. The patient was a 7-year-old
female with a normal birth and developmental history who first presented 6 weeks after
a right ankle sprain with pain localized to the lateral calcaneus. Prominent swelling
and tenderness to palpation were noted over the peroneal tubercle. Radiographic imaging
showed dystrophic calcification within the peroneus brevis tendon. After failed conservative
management, the heterotopic ossified mass (1.5 × 0.3 cm) was excised from the peroneus
brevis tendon. The tendon was primarily repaired. The patient was followed up for
12 weeks postoperatively and achieved full resolution of her pain with a return to
normal activity. HO has been theorized to be the result of an imbalance between bone
mineralization and demineralization. In the setting of localized trauma, inductive
agents have been implicated in pathologic bone formation. In the pediatric population,
HO has rarely been diagnosed in the absence of genetic causes. In patients presenting
with lateral foot and ankle pain, HO of the peroneal tendons should be considered
in the differential diagnosis. In a patient with pain secondary to HO, surgical excision
of the heterotopic mass can achieve symptom resolution.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: June 21, 2017
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
