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The os vesalianum is an uncommon pedal accessory bone located lateral to the fifth metatarsal base. It may occasionally become symptomatic and require surgical excision, as in the case reported here in a 24-year-old woman. Simple excision of the ossicle, while effective in the present case, can be complicated by the attachment of fibers of the peroneus brevis tendon into the ossicle, thus requiring careful tenorraphy and sometimes tenodesis. (J Am Podiatr Med Assoc 101(4): 356–359, 2011)