Beaks and peaks in adult skeleton, Part II: Bony excrescences in lower extremity

Zehra Akkaya, Gülden Şahin


Bony protuberances are frequently seen in imaging of the adult skeleton. Congenital or acquired, some of these bony excrescences can be clues to the underlying disorder in the appropriate clinical context. It is important to know their imaging findings and typical location in order to establish an accurate diagnosis and have a grasp on their clinical significance. The first part of this review series covered the upper extremity and skull base. In this second part, we briefly describe common and clinically important bony excrescences in the lower extremity.



Deformity; exostoses; lower extremity; MR imaging; radiography;

Full Text:



Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 2016; 50(19): 1169-1176.

Siebenrock KA, Wahab KH, Werlen S, et al. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res 2004; (418): 54-60.

Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003; (417): 112-120.

Dickenson E, Wall PD, Robinson B, et al. Prevalence of cam hip shape morphology: a systematic review. Osteoarthritis Cartilage 2016; 24(6): 949-961.

Ricciardi BF, Fields K, Kelly BT, et al. Causes and risk factors for revision hip preservation surgery. Am J Sports Med 2014; 42(11): 2627-2633.

Wong TT, Igbinoba Z, Bloom MC, et al. Anterior inferior iliac spine morphology: Comparison of symptomatic hips with femoroacetabular impingement and asymptomatic hips. AJR Am J Roentgenol 2019; 212(1): 166-172.

Hetsroni I, Poultsides L, Bedi A, et al. Anterior inferior iliac spine morphology correlates with hip range of motion: a classification system and dynamic model. Clin Orthop Relat Res 2013; 471(8): 2497-2503.

Blankenbaker DG, Tuite MJ. Non-femoroacetabular impingement. Semin Musculoskelet Radiol 2013; 17(3): 279-285.

Sutter R, Pfirrmann CW. Atypical hip impingement. AJR Am J Roentgenol 2013; 201(3): W437-442.

Larson CM, Kelly BT, Stone RM. Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy 2011; 27(12): 1732-1737.

Matsuda DK, Calipusan CP. Adolescent femoroacetabular impingement from malunion of the anteroinferior iliac spine apophysis treated with arthroscopic spinoplasty. Orthopedics 2012; 35(3): e460-463.

Resnick JM, Carrasco CH, Edeiken J, et al. Avulsion fracture of the anterior inferior iliac spine with abundant reactive ossification in the soft tissue. Skeletal Radiol 1996; 25(6): 580-584.

Yildiz C, Yildiz Y, Ozdemir MT, et al. Sequential avulsion of the anterior inferior iliac spine in an adolescent long jumper. Br J Sports Med 2005; 39(7): e31.

Nawabi DH, Degen RM, Fields KG, et al. Anterior inferior iliac spine morphology and outcomes of hip arthroscopy in soccer athletes: A comparison to nonkicking athletes. Arthroscopy 2017; 33(4): 758-765.

Herregods N, Dehoorne J, Pattyn E, et al. Diagnositic value of pelvic enthesitis on MRI of the sacroiliac joints in enthesitis related arthritis. Pediatr Rheumatol Online J 2015; 13(1): 46.

Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986; 29(8): 1039-1049.

Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16(4): 494-502.

Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010; 26(3): 355-369.

Kitsoulis P, Galani V, Stefanaki K, et al. Osteochondromas: review of the clinical, radiological and pathological features. In Vivo 2008; 22(5): 633-646.

Murphey MD, Choi JJ, Kransdorf MJ, et al. Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics 2000; 20(5): 1407-1434.

Giudici MA, Moser RP Jr, Kransdorf MJ. Cartilaginous bone tumors. Radiol Clin North Am 1993; 31(2): 237-259.

Villiger KJ. [“Clothes-hook” exostosis]. [Article in German]. Chirurg 1974; 45(10): 480-482.

Ugai K, Sato S, Matsumoto K, et al. A clinicopathologic study of bony spurs on the pes anserinus. Clin Orthop Relat Res 1988; (231): 130-134.

Fraser RK, Nattrass GR, Chow CW, et al. Pes anserinus syndrome due to solitary tibial spurs and osteochondromas. J Pediatr Orthop 1996; 16(2): 247-248.

Bock GW, Bosch E, Mishra DK, et al. The healed Segond fracture: a characteristic residual bone excrescence. Skeletal Radiol 1994; 23(7): 555-556.

Dietz GW, Wilcox DM, Montgomery JB. Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology 1986; 159(2): 467-469.

Weber WN, Neumann CH, Barakos JA, et al. Lateral tibial rim (Segond) fractures: MR imaging characteristics. Radiology 1991; 180(3): 731-734.

Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol 1988; 151(6): 1163-1167.

Escobedo EM, Mills WJ, Hunter JC. The “reverse Segond” fracture: association with a tear of the posterior cruciate ligament and medial meniscus. AJR Am J Roentgenol 2002; 178(4): 979-983.

Mendes LF, Pretterklieber ML, Cho JH, et al. Pellegrini-Stieda disease: a heterogeneous disorder not synonymous with ossification/calcification of the tibial collateral ligament-anatomic and imaging investigation. Skeletal Radiol 2006; 35(12): 916-922.

Klontzas ME, Akoumianakis ID, Vagios I, et al. MR imaging findings of medial tibial crest friction. Eur J Radiol 2013; 82(11): e703-706.

McGonagle D, Gibbon W, O’Connor P, et al. Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum 1998; 41(4): 694-700.

Emad Y, Ragab Y, Bassyouni I, et al. Enthesitis and related changes in the knees in seronegative spondyloarthropathies and skin psoriasis: magnetic resonance imaging case-control study. J Rheumatol 2010; 37(8): 1709-1717.

Greenspan A, Norman A, Tchang FK. “Tooth” sign in patellar degenerative disease. J Bone Joint Surg Am 1977; 59(4): 483-485.

Hardy JR, Chimutengwende-Gordon M, Bakar I. Rupture of the quadriceps tendon: an association with a patellar spur. J Bone Joint Surg Br 2005; 87(10): 1361-1363.

Berberian WS, Hecht PJ, Wapner KL, et al. Morphology of tibiotalar osteophytes in anterior ankle impingement. Foot Ankle Int 2001; 22(4): 313-317.

Robinson P, White LM, Salonen D, et al. Anteromedial impingement of the ankle: using MR arthrography to assess the anteromedial recess. AJR Am J Roentgenol 2002; 178(3): 601-604.

Morris LH. Athlete’s ankle. J Bone Joint Surg Am 1943; 25: 220.

Tol JL, van Dijk CN. Etiology of the anterior ankle impingement syndrome: a descriptive anatomical study. Foot Ankle Int 2004; 25(6): 382-386.

Berman Z, Tafur M, Ahmed SS, et al. Ankle impingement syndromes: an imaging review. Br J Radiol 2017; 90(1070): 20160735.

Aparisi Gomez MP, Aparisi F, Bartoloni A, et al. Anatomical variation in the ankle and foot: from incidental finding to inductor of pathology. Part I: ankle and hindfoot. Insights Imaging 2019; 10(1): 74.

Wiegerinck JI, Vroemen JC, van Dongen TH, et al. The posterior impingement view: an alternative conventional projection to detect bony posterior ankle impingement. Arthroscopy 2014; 30(10): 1311-1316.

Resnick D. Talar ridges, osteophytes, and beaks: a radiologic commentary. Radiology 1984; 151(2): 329-332.

Conway JJ, Cowell HR. Tarsal coalition: clinical significance and roentgenographic demonstration. Radiology 1969; 92(4): 799-811.

Burman M. Stenosing tendovaginitis of the foot and ankle; studies with special reference to the stenosing tendovaginitis of the peroneal tendons of the peroneal tubercle. AMA Arch Surg 1953; 67(5): 686-698.

Ochoa LM, Banerjee R. Recurrent hypertrophic peroneal tubercle associated with peroneus brevis tendon tear. J Foot Ankle Surg 2007; 46(5): 403-408.

Saupe N, Mengiardi B, Pfirrmann CW, et al. Anatomic variants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic ankles. Radiology 2007; 242(2): 509-517.

Oestreich AE, Mize WA, Crawford AH, et al. The “anteater nose”: a direct sign of calcaneonavicular coalition on the lateral radiograph. J Pediatr Orthop 1987; 7(6): 709-711.

Chapman VM. The anteater nose sign. Radiology 2007; 245(2): 604-605.

Stormont DM, Peterson HA. The relative incidence of tarsal coalition. Clin Orthop Relat Res 1983; (181): 28-36.

Sartoris DJ, Resnick DL. Tarsal coalition. Arthritis Rheum 1985; 28(3): 331-338.

Rubin G, Witten M. Plantar calcaneal spurs. Am J Orthop 1963; 5: 38-41.

Abreu MR, Chung CB, Mendes L, et al. Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis. Skeletal Radiol 2003; 32(1): 13-21.

Kopell HP, Thompson WA. Peripheral entrapment neuropathies of the lower extremity. N Engl J Med 1960; 262: 56-60.

Przylucki H, Jones CL. Entrapment neuropathy of muscle branch of lateral plantar nerve: a cause of heel pain. J Am Podiatry Assoc 1981; 71(3): 119-124.

Donovan A, Rosenberg ZS, Cavalcanti CF. MR imaging of entrapment neuropathies of the lower extremity. Part 2. The knee, leg, ankle, and foot. Radiographics 2010; 30(4): 1001-1019.

Resnick D, Feingold ML, Curd J, et al. Calcaneal abnormalities in articular disorders. Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and Reiter syndrome. Radiology 1977; 125(2): 355-366.

Malhotra CM, Lally EV, Buckley WM. Ossification of the plantar fascia and peroneus longus tendons in diffuse idiopathic skeletal hyperostosis (DISH). J Rheumatol 1986; 13(1): 215-218.

McCarthy DJ, Gorecki GE. The anatomical basis of inferior calcaneal lesions. A cryomicrotomy study. J Am Podiatry Assoc 1979; 69(9): 527-536.

Sebes JI. The significance of calcaneal spurs in rheumatic diseases. Arthritis Rheum 1989; 32(3): 338-340.

Sella EJ, Caminear DS, McLarney EA. Haglund’s syndrome. J Foot Ankle Surg 1998; 37(2): 110-114; discussion 173.

Pavlov H, Heneghan MA, Hersh A, et al. The Haglund syndrome: initial and differential diagnosis. Radiology 1982; 144(1): 83-88.

Lawrence DA, Rolen MF, Morshed KA, et al. MRI of heel pain. AJR Am J Roentgenol 2013; 200(4): 845-855.

Gill CM, Taneja AK, Bredella MA, et al. Osteogenic relationship between the lateral plantar process and the peroneal tubercle in the human calcaneus. J Anat 2014; 224(2): 173-179.

Montiel V, Alfonso M, Villas C, et al. Medial and lateral exostoses of the distal phalanx of the hallux: A potentially painful bunion-like structure. Part 1: Incidence and clinical application. Foot Ankle Surg 2019; 25(2): 158-164.

Garcia Carmona FJ, Pascual Huerta J, Fernandez Morato D. A proposed subungual exostosis clinical classification and treatment plan. J Am Podiatr Med Assoc 2009; 99(6): 519-524.



  • There are currently no refbacks.