Investigation and Management of Painful Os Peroneum Syndrome: A Narrative Review of the Current Literature

Painful Os Peroneum Syndrome (POPS) is a rare cause of lateral midfoot pain due to pathologies involving the os peroneum, an accessory ossicle within the peroneus longus tendon. POPS may result from fractures, tendon tears, tenosynovitis, or degenerative changes. This review evaluates outcomes of conservative and surgical management of POPS based on the current literature. A comprehensive review of published case reports, series, and relevant studies on POPS management was conducted. Clinical outcomes, radiographic findings, and complications following conservative and surgical interventions were analysed. Conservative management, including immobilisation, physiotherapy, cryotherapy, and corticosteroid injections, showed variable success, particularly in nondisplaced fractures or inflammatory causes. Surgical management demonstrated better outcomes in severe cases, including displaced fractures or tendon ruptures. Techniques such as os peroneum excision, tendon repair, tenodesis to the peroneus brevis, and tendon grafting yielded high patient satisfaction, reduced pain scores, and improved functional outcomes. Reported complications included delayed wound healing, sural neuritis, and chronic pain. Despite promising surgical results, a lack of standardised treatment protocols remains a challenge. Both conservative and surgical management of POPS can be effective, depending on injury severity and pathology. Surgical intervention appears superior for advanced cases, especially with tendon rupture or os peroneum fracture. Further research with standardised scoring systems and larger cohorts is needed to establish optimal treatment algorithms and improve clinical outcomes.