Os Trigonum Syndrome Research Articles

Foot pain in children and adolescents: a problem-based approach in musculoskeletal ultrasonography.

Various etiologies and risk factors contribute to foot pain in children and adolescents, including conditions such as Kohler's disease, Sever's disease, Iselin's disease, rigid flat foot, accessory navicular, Freiberg's disease, sesamoiditis, os trigonum syndrome, and more. High-frequency musculoskeletal ultrasonography can show both the bone surface and the surrounding soft tissue clearly from various angles in real-time, thereby providing a higher level of detail that is helpful for identifying the etiology of foot pain and monitoring disease progression compared with other imaging modalities. This review provides an overview of the epidemiology, pathophysiology, clinical manifestations and characteristic ultrasonographic findings of select foot pain conditions in children and adolescents.

Os Trigonum Syndrome: A Cause of Posterior Ankle Pain.

Os trigonum syndrome represents a cause of posterior ankle pain that is predominantly seen in athletes. The os trigonum ossicle forms from a secondary ossification center of the talus and is located at its posterior aspect in an interval between the posterior lip of the tibial plafond and calcaneus. The os trigonum ossicle is often an incidental finding and asymptomatic. However, repetitive plantarflexion and push-off maneuvers can cause symptoms and lead a patient to pursue orthopedic care. A review of the literature was conducted using the PubMed search engine with the following keywords: "os trigonum", "os trigonum ossicle", "os trigonum syndrome", "posterior ankle impingement", and "Stieda process". The pertinent anatomy, clinical presentation, diagnostic evaluation, and treatment of os trigonum syndrome were reviewed in the literature and are extensively discussed in this article. Os trigonum syndrome represents a potential cause of posterior ankle pain that needs thorough evaluation regarding history, physical examination, and imaging. Once diagnosed, treatment ranges from conservative to surgical interventions depending on surgeon preference and specific case presentation. [Orthopedics. 2024;47(2):e67-e72.].

The Utilization of Minimally Invasive Surgery for Os Trigonum Syndrome: A Systematic Review

Background: A symptomatic os trigonum is a common cause of posterior ankle pain that has been traditionally managed with open excision. Minimally invasive surgery (MIS) has been proposed as an alternative to open excision for improved outcomes and decreased complication rates; however, no systematic review to date has examined the utilization of MIS for a symptomatic os trigonum. Purpose: To examine patient outcomes, return to sport, and complications associated with MIS for a symptomatic os trigonum. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed on February 22, 2023, using the PubMed, CINAHL, MEDLINE, and Web of Science databases from database inception until February 22, 2023, on the topic of MIS for a symptomatic os trigonum. Results: Of 885 articles retrieved from an initial search, 17 articles (N = 435 patients) met full inclusion criteria. The mean age of the cohort was 26.01 ± 4.68 years, with a mean follow-up time of 34.63 ± 18.20 months. For patients treated with MIS, the mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 55.85 ± 12.75, the mean final postoperative AOFAS score was 94.88 ± 4.04, the mean preoperative visual analog scale pain score was 7.20 ± 0.43, and the mean final postoperative visual analog scale score was 0.71 ± 0.48. The mean time to return to sport for patients undergoing MIS was 7.76 ± 1.42 weeks. MIS had an overall complication rate of 5.0%, the majority of which consisted of transient neurapraxia of the sural or superficial peroneal nerve. Conclusion: Minimally invasive management of a symptomatic os trigonum appears to be a viable alternative to open surgery in terms of outcomes, return to sport, and complication rates. More high-quality evidence will be required to definitely recommend minimally invasive approaches as the standard of care over open surgery.

Clinical and radiological results of posterior ankle endoscopy treatment for the flexor hallusis longus tenosynovitis and os trigonum syndrome

Objectives: This study investigated the effect of two portal posterior ankle arthroscopy (PAA) procedures using American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analog Scale (VAS) scores for the treatment of patients with ankle pain associated with Os trigonum (OT) and Flexor hallusis longus (FHL) tenosynovitis. The effect of PAA treatment on the degree and localization of effusion around the FHL tendon was also investigated. Methods: Between March 2016 and August 2021, 41 patients who underwent PAA with the diagnosis of OT and stenosing FHL tenosynovitis, whose arthroscopy video records could be reviewed retrospectively, and who had at least 1 year of follow-up results were included in the study. Patients in the pediatric age group, diabetes patients, patients with inflammatory disease, and those with subtalar and tibiotalar osteoarthritis were excluded from the study. Preoperative and postoperative physical examinations, lateral radiography of the pressing foot, MRI, and the VAS and AOFAS scores were evaluated. In the statistical analysis, data were statistically analyzed using SPSS 19.0 (SPSS, Chicago, Illinois, USA). p < 0.05 was accepted as statistically significant. Results: The mean age was 35.6 years (range: 19-55), among which the mean age of the women was 36.2 years (range: 24-48), and the mean age of the men was 35.2 years (range: 19-55). The mean follow-up was 34 months (range: 14-62). The AOFAS value increased from 38.61 ± 7.176 preoperatively to 89.83 ± 6.34 at the postoperative follow-up, and the difference was statistically significant (p < 0.001). Five patients fully regained their normal function (AOFAS score = 100 points). The VAS value increased from 90 ± 5.916 preoperatively to 18.682 ± 7.688 at the last postoperative follow-up, and the difference was statistically significant (p < 0.001). Pre-PAA FHL tenosynovitis was seen only in zone 1 in 26 patients, zones 1 and 2 in 14 patients, and in zones 1, 2, and 3 in two patients. There was no significant decrease in effusion in the magnetic resonance imaging (MRI) at 1 month after the PAA (p = 0.117). A significant decrease in effusion was observed in the MRI taken at the last control (p < 0.001). Conclusions: In the treatment of patients with ankle pain associated with OT and FHL tenosynovitis, the two-portal PAA treatment was observed to be an effective method that resulted in significant improvement in the AOFAS and VAS scores.

Functional Outcomes of Arthroscopic OS Trigonum Excision in Adolescents

Background:Outcomes of symptomatic os trigonum excision have been well described as a successful treatment in adults; however, the literature lacks information on standardized longer term functional outcomes in the pediatric population.Hypothesis/Purpose:This study intends to report functional outcomes of arthroscopic os trigonum excision in adolescents who failed conservative management, with the hypothesis that these younger patients would have similar, successful outcomes of adult patients.Methods:A retrospective study was performed on adolescents who underwent arthroscopic os trigonum excision at a single institution between 2011 and 2017. Patient demographic, clinical history, radiographic, and operative data were documented. Outcome measures included the Foot and Ankle Ability Measure (FAAM) score comprised of the Activities of Daily Living (ADL) and Sports subscales, Single Assessment Numeric Evaluation (SANE) score, ability to return to the same level of sport, and any additional foot/ankle surgery.Results:Ten patients (12 ankles) met criteria with a mean age at surgery of 15.4 years (range, 12 to 18 years) and a mean follow-up of 6.5 years (range, 2.8 to 9.1 years). Mean FAAM ADL subscale, Sports subscale, and SANE scores were 91.0 ± 15.5, 76.3 ± 29.1, and 88.6 ± 15.1 respectively. A chronic duration of symptoms prior to surgery was associated with a lower FAAM Sports current level of function score (p=0.032). Four patients (40%) discontinued their sport due to continued ankle issues and reported significantly lower FAAM ADL subscale (p=0.01), Sports subscale (p<0.001), and SANE scores (p = 0.002).Conclusion:Os trigonum syndrome in the adolescent population may not have the same rate of success as that seen in adult athletes over the long term. However, if proven to be refractory to conservative measures and surgical intervention is indicated, patients and their families should be counseled about the risk for persistent ankle symptoms and the possibility that they may not be able to return to their previous level of sport.

Atypical Os trigonum syndrome: a case of FHL entrapment

&lt;p class="abstract"&gt;Os trigonum is an accessory bony growth from posterior aspect of talus, which presents as swelling and pain behind the ankle causing hinderance to daily activities secondary to impingement. The overuse of ankle with repetitive stress on plantar flexion is usually seen in ballet dancers. Unusual cases can be seen irrespective of the profession and can be symptomatic. Sometimes symptomatic patients may improve with activity modification and rest. Syndromic involvement is featured by entrapment of FHL tendon. In that case, excision of the mass with entrapment release can improve the functional outcome.&lt;/p&gt;

Radiological study of Os trigonum and its clinical significance

Background: Os trigonum (OST) is commonly located on the posterior aspect of the talus. It occurs as a result of secondary ossification center failing to fuse with the lateral tubercle of the posterior process of the talus; its incidence varies between 2 and 25%, and is more often bilateral. It occurs as an intra-articular Os, which is most often securely rooted to the lateral tubercle of the talus by a fibrocartilaginous synchondrosis. Aims and Objective: To determine the incidence, morphology, and distribution of Os Trigonum (OST). Materials and Methods: Retrospective 500 lateral foot radiographs view were studied to determine the incidence, morphology, and distribution of OST. Results: Incidence of OST in the present study was 6.6%, with predominantly round or ovoid in shape. OST was located on the posterolateral aspect of the talus. Conclusion: OST can be one of the causative factor responsible for Flexor hallucis longus tendonitis, OST syndrome, which occur in plantarflexion of the ankle, leading to compression of the OST between the distal tibia and the calcaneus. Hence, knowledge regarding the incidence, morphology, and distribution of OST is important for the radiologist, orthopedic surgeons to arrive at a correct diagnosis, which aids in the management of cases presenting with complaints of posterior ankle pain.

Functional Outcomes of Arthroscopic Os Trigonum Excision in Adolescents.

Outcomes of symptomatic os trigonum excision have been well described as a successful treatment in adults; however, the literature lacks information on standardized longer term functional outcomes in the pediatric population. This study intends to report functional outcomes of arthroscopic os trigonum excision in adolescents who failed conservative management, with the hypothesis that these younger patients would have similar, successful outcomes of adult patients. A retrospective study was performed on adolescents who underwent arthroscopic os trigonum excision at a single institution between 2011 and 2017. Patient demographic, clinical history, radiographic, and operative data were documented. Outcome measures included the Foot and Ankle Ability Measure (FAAM) score comprised of the Activities of Daily Living (ADL) and Sports subscales, Single Assessment Numeric Evaluation (SANE) score, ability to return to the same level of sport, and any additional foot/ankle surgery. Ten patients (12 ankles) met criteria with a mean age at surgery of 15.4 years (range, 12 to 18 y) and a mean follow-up of 6.5 years (range, 2.8 to 9.1 y). Mean FAAM ADL subscale, Sports subscale, and SANE scores were 91.0±15.5, 76.3±29.1, and 88.6±15.1, respectively. A chronic duration of symptoms before surgery was associated with a lower FAAM Sports current level of function score (P=0.032). Four patients (40%) discontinued their sport due to continued ankle issues and reported significantly lower FAAM ADL subscale (P=0.01), Sports subscale (P<0.001), and SANE scores (P=0.002). Os trigonum syndrome in the adolescent population may not have the same rate of success as that seen in adult athletes over the long-term. However, if proven to be refractory to conservative measures and surgical intervention is indicated, patients and their families should be counseled about the risk for persistent ankle symptoms and the possibility that they may not be able to return to their previous level of sport. Level IV-case series.

Surgical Outcomes of Os Trigonum Syndrome in Dancers: A Case Series.

Background:Management of ankle pain in dancers can be challenging because of the repetitive stress and complex demands placed on this region. Despite the prevalence of ankle injuries in this population, literature on surgical outcomes and return to dance is limited.Purpose:To retrospectively evaluate the efficacy and functional outcomes after surgical excision of a symptomatic os trigonum in dancers.Study Design:Case series; Level of evidence, 4.Methods:Between June 2006 and June 2016, a total of 44 dancers underwent surgical excision of a symptomatic os trigonum at a single institution and by a single surgeon. All patients presented with symptoms of posterior ankle impingement syndrome and subsequently failed nonsurgical treatment. Clinical analysis was conducted using various pre- and postoperative patient-reported outcome questionnaires, including the Veterans RAND 12-Item Health Survey (VR-12), Foot Function Index–Revised (FFI-R), and visual analog scale (VAS) for pain, as well as subjective patient satisfaction.Results:A total of 44 patients (54 ankles; mean age, 18.2 years) were retrospectively evaluated at a mean follow-up of 33.4 months. The VR-12 Physical Health score improved from a mean score of 37.8 ± 11.9 to 51.2 ± 10.5 (P < .001). The cumulative FFI-R score improved from 46.45 ± 13.8 to 31.2 ± 9.7 (P = .044), with the subcategory of “activity limitation” representing the highest-scoring FFI-R subcategory at 65.28 ± 13.4 preoperatively and improving to 34.47 ± 12.4 at follow-up (P < .001). The mean VAS score for subjective pain improved significantly from 5.39 ± 2.84 to 1.73 ± 2.10 (P < .00044).Conclusion:Overall, the findings of the present study demonstrate that dancers of varying style and level improved significantly according to various clinical measures. Patients included in this study reported that they returned to their previous level of dance upon completion of physical therapy and maintained thriving postoperative careers, which for several meant dancing at the professional level.

Incidence of symptomatic os trigonum among nonathletic patients with ankle sprain.

Os trigonum syndrome is a rare condition, often affecting athletes. A paucity of data exists on the incidence of os trigonum syndrome in nonathletic population. The study aimed to determine the incidence and clinical characteristics of os trigonum syndrome in nonathletic patients with sprained ankles. The sample consisted of 798 adolescent and adult patients that attended the emergency department or Foot and Ankle Clinic with acute ankle sprain. Lateral and/or oblique lateral radiographs of the feet were screened for the presence of os trigonum in relation to age and gender. A cohort of 163 patients with os trigonum was followed up prospectively over a 48-month period to correlate the presence of the os trigonum with patient symptomatology. Os trigonum was found in 20.4% (163/798) of sprained ankles. Patients aged 18-35 exhibited most os trigonum [42.3% (69/163)], with higher incidence in females. 5.5% (9/163) of the os trigonum patients developed an os trigonum syndrome after a standard treatment of an ankle sprain [3.8% (3/78) of males and 7.1% (6/85) of females]. Females aged between 18 and 35years had higher incidence of os trigonum syndrome compared to males of a similar age. Os trigonum syndrome should be suspected in nonathletic patients with an ankle sprain unresponsive to standard treatment. About 1.1% of acute ankle sprain patients develop an os trigonum syndrome. This finding can help identify the source of a patient's symptoms, leading to an accurate diagnosis, appropriate treatment and reducing the potential chronic symptoms.

The Prevalence and Clinical Significance of FHL Tears in Athletes with Posterior Ankle Impingement Surgery

Category:Ankle, Hindfoot, SportsIntroduction/Purpose:Posterior ankle pain in the athlete is common and thought to be caused by Flexor Hallucis Longus (FHL) tendon tear/tendinopathy or Os trigonum syndrome. The association of flexor hallucis longus (FHL) pathology in conjunction with PAIS has not been described. The purpose of this study is to report the prevalence of FHL tears in athletes who undergo surgical treatment for PAIS. We also report the outcome of 36 athletes treated with FHL repair with PAIS surgery and compare them to 122 athletes undergoing PAIS surgery without FHL tears. The utility of advanced imaging, standardized outcome scores at standard post-operative time intervals, return to sport (RTS) and time to RTS were all evaluated in the 158 athletes.Methods:Our clinical database was searched for appropriate surgical codes, and patients from 1996 through March 2016 were retrospectively collected. Inclusion criteria included surgical treatment of PAIS, age between ten and 50, and participation in recreational or competitive athletics. Exclusion criteria included other injuries that could affect return to sport or recovery process. 158 patients met these criteria, (36 dancers, 122 non-dancers). Pre-operative imaging, operative records, dorsiflexion range of motion at six weeks and one year postoperatively, and time to return to sport are reported. AAOS Foot & Ankle, and Lower Limb Core Module (FALLC) scores were obtained (six weeks, three months, and one year post-operatively). Questionnaire data and functionality scores were compared between the two groups using two-sample Student t-tests. Categorical data outcomes were compared using chi-square tests or Fisher’s exact tests.Results:74/158 patients had magnetic resonance imaging (MRI) pre-operatively. 5/14 patients with an FHL tear had positive MRI suggesting an FHL tear, 9/14 patients with FHL tear had negative MRI (sensitivity of 0.26). FHL tears occurred in 36/158 (23%) of athletes with PAIS, 16/36 (44.4%) of dancers and 20/122 (16.4%) non-dancers. RTS did not differ between athletes with and without FHL tears, but time until RTS increased-average of 13.5 days (67.5 versus 81) with FHL repairs. Dancers with FHL tears reported increased foot pain and lower foot and ankle function at 3 months relative to those without tears. Scores were similar at one year.Conclusion:FHL tears in athletes undergoing surgical treatment for PAIS is 23% and in dancers can be as high as 44%. Pre- operative MRI has a poor sensitivity for FHL tears in this population. Concomitant FHL tear with repair during PAIS surgery does not decrease the rate of RTS or long term overall outcome. Overall, dancers have a higher rate of FHL tear at time of PAIS than non-dancers. FHL results in only a mild delay in RTS time. This is the first study to note FHL tear rate in association with PAI surgery.

Ankle Injuries in Dancers.

The term dance encompasses a broad range of different styles; much of the orthopaedic literature has focused on ballet dancers. Injury is common in dancers at all levels, and many serious dancers sustain multiple injuries as they progress through their career. Foot and ankle injuries are among the most common injuries experienced by dancers. These injuries include those that are specific to dancers because of the unique physical maneuvers required to effectively perform, but they can also include common injuries that may require relatively different treatment because of the physical demands of the dancer. Os trigonum syndrome and flexor hallucis longus tenosynovitis generally fall into the former category as they are injuries that are more prevalent in dancers due to the extreme plantarflexion involved in dancing, especially ballet, and the relative demand placed on the toe flexors, most notably the flexor hallucis longus. On the other hand, anterior ankle impingement occurs both in dancers and in the general public. In many cases, a team approach to treatment with knowledgeable physical therapists can obviate the need for surgical treatment. If surgical treatment proves necessary, good results can be achieved with sound surgical technique and a well thought-out rehabilitation program.

Surgical Outcomes of Os Trigonum Syndrome in Dancers

Surgical Outcomes of Os Trigonum Syndrome in Dancers

Chronic lateral ankle instability increases the likelihood for surgery in athletes with os trigonum syndrome

PurposeThe etiology and incidence of os trigonum syndrome in professional athletes is highly variable. There is a paucity of data to ascertain why some athletes evolve towards surgery whilst others remain asymptomatic. We hypothesized that a lateral ligament ankle injury would increase the likelihood for surgery in those athletes with os trigonum syndrome.MethodsEighty professional athletes with clinical and radiological signs of os trigonum syndrome were identified to ascertain the incidence of injury to the lateral ligamentous ankle complex (acute and chronic) by magnetic resonance imaging (MRI). This cohort was subdivided into 2 groups; a surgical (n = 40) and a non-surgical (n = 40) cohort. Surgical division was decided if (1) the clinical hyper-plantar flexion test was positive, (2) a positive diagnostic ultrasound-guided injection and (3) no improvement was observed after 6 weeks of conservative rehabilitation.ResultsFrom the surgical cohort, 37 players (94.1%) had a chronic lateral ankle ligament injury on MRI, whilst 3 players (5.9%) had an acute lateral ankle ligament injury. Binary logistic linear modelling revealed that having a chronic lateral ligament injury increases the likelihood of os trigonum syndrome surgery by ten times compared to those with an acute lateral ligament injury.ConclusionProfessional athletes with chronic lateral ligament ankle injury have an approximate ten times greater risk for os trigonum syndrome surgery compared to athletes with acute lateral ligament ankle injury.Level of evidenceIV.

Overuse Injuries in Professional Ballet: Influence of Age and Years of Professional Practice.

Background:In spite of the high rate of overuse injuries in ballet dancers, no studies have investigated the prevalence of overuse injuries in professional dancers by providing specific diagnoses and details on the differences in the injuries sustained as a function of age and/or years of professional practice.Hypothesis:Overuse injuries are the most prevalent injuries in ballet dancers. Professional ballet dancers suffer different types of injuries depending on their age and years of professional practice.Study Design:Descriptive epidemiology study.Methods:This descriptive epidemiological study was carried out between January 1, 2005, and October 10, 2010, regarding injuries sustained by professional dancers belonging to the major Spanish ballet companies practicing classical, neoclassical, contemporary, and Spanish dance. The sample was distributed into 3 different groups according to age and years of professional practice. Data were obtained from the specialized medical care the dancers received from the Trauma and Orthopaedic Surgery Service at Fremap in Madrid. The dependent variable was the study of the injury.Results:A total of 486 injuries were identified over the study period, with overuse injuries being the most common etiology (P < .0001); these injuries were especially prevalent in junior professional dancers practicing classical ballet and veteran dancers practicing contemporary ballet (P = .01). Specifically, among other findings, stress fractures of the base of the second metatarsal (P = .03), patellofemoral syndrome, and os trigonum syndrome were more prevalent among junior professionals (P = .04); chondral injury of the knee in senior professionals (P = .04); and cervical disc disease in dancers of intermediate age and level of experience.Conclusion:Overall, overuse injuries were more prevalent in younger professionals, especially in women. This finding was especially true for the more technical ballet disciplines. On the other hand, in the athletic ballet disciplines, overuse lesions occurred mainly in the more senior professionals.Clinical Relevance:This study provides specific clinical diagnoses obtained through physical examination as well as details on the different injury types sustained as a function of age and/or years of professional practice, an important aspect for ballet and sports practice in general.

An Unusual Os Trigonum Syndrome Case Secondary to Car Accident: A Case Report

Introduction: The os trigonum syndrome is a common cause of posterior ankle pain, often affecting ballet dancers, soccer players, runners and gymnasts who frequently force the ankle into plantar flexion. In rare cases, onset of the os trigonum syndrome followed an acute injury. Case Presentation: A 62-year-old female patient was admitted with load depended ankle pain and swelling, lasting for five years which promptly started after a car accident. We incidentally discovered os trigonum on plain radiography on a lateral view of the right ankle. Conclusions: The os trigonum syndrome should take in consideration in elderly subject who had posterior ankle pain starting after a car accident.

Os Trigonum syndrome – A case report

The ostrigonum is a small bone present on the posterolateral aspect of the talus. It is formed from a separate ossification center which fails to unite with the talus itself. Incidence is about 3-15% .The diagnosis can be difficult to make as symptoms and physical exam findings mimic those that occur withproblems related to an accessory soleus muscle, flexor hallucislongus, posteriortibialis, or peroneal tendons, arthritis involving the posterior tibiotalar or subtalar joints, or ostrigonum syndrome. Misdiagnosis of such injuries may result in inadequate management including immediate weight bearing and prolonged symptoms.

Posterior Ankle and Hind Foot Arthroscopy

Objectives:While anterior ankle arthroscopy is a widely accepted technique, posterior ankle/hind foot arthroscopy is still a relatively new procedure. The arthroscopic visualisation was often initially limited and vulnerabilty of the posteromedial neurovascular structures to injury scared orthopaedic surgeons. The goal of this review is to highlight the indications, and to present the long term follow up results of posterior ankle/hind foot arthroscopy.Methods:The study included 21 ankles in 21 patients (12 male and 9 female ).The mean age was 37.7 , the mean duration of preoperative symptoms 12.8 months . Arthroscopy performed with the patient prone , under general and spinal anesthesia with tourniquet hemostasis . Preoperative intravenous antibiotic prophylaxis is performed (cefazolin 1g) , sand bag placed under ipsilateral anteresuperior iliac spine to correct natural external rotated posture of the ankle and ankle is left hanging of the table so that it can moved freely during surgery. We applied noninvasive distraction method with simple rope which tied and knotted waist of the surgeon . The posterolateral and posteromedial portals which described by Van Dijk was utilized . The arthroscopic visualisation was often initially limited and careful debritement of some adipose tissue of the kager fat pad (Kager's fat pad, also known as the pre-Achilles fat pad) was necessary to create more space to aid visualization .The most valuable point to stay clear from trouble is to understand , know and aware where the flexor hallucis longus tendon exist .So neurovascular structures located beyond this tendon. Principally the process must advance into lateral to medial manner. The mean follow up period was 55 months. The most common preoperative diagnoses were osteochondral lesions of talus (ten ),painful os trigonum syndrome with (five )or without (three) FHL tenosynovitis (total eight ), posterior talofibular ligament thickenning (two ), Haglund’s deformity (one )Results:The mean pre operative AOFAS score was 50.75, the mean post operative AOFAS score was 93.75. Complications were noted. Complex regional pain syndrome (CRPS) and oedema was diagnosed during early post operative period in one patient (%4.7), resolved with physical therapy.Conclusion:The most common procedures were osteochondral lesion debritement and curettage with multidrilling /microfracture (10), isolated os trigonum excision (2), tenolysis of the flexor hallucis longus tendon with os trigonum excision (6 ), debritment of the thickened posterior talofibular ligament (2), endoscopic partial calcanectomy for Haglund’s deformity (1) . Our experience demostrated that posterior ankle and hind foot arthroscopy can be performed with low rate of major postoperative complication.

Endoscopic repair of posterior ankle impingement syndrome due to os trigonum in soccer players.

An os trigonum may cause posterior ankle impingement syndrome (PAIS), which may lead to poor sports performance, especially in soccer players. The aim of the present study was to analyze the outcomes of endoscopic repaired posterior ankle impingement (PAI) secondary to os trigonum syndrome within a group of soccer players as well as their return to play time. A retrospective review of 20 soccer players with Tegner activity level 9 was performed. All players were diagnosed of PAIS due to os trigonum. Chief complaint was pain produced with forced plantarflexion when kicking the ball. Conservative treatment was first performed during a 6-week rehabilitation program. When conservative treatment failed, arthroscopic surgical resection of the os trigonum was proposed. Visual analogue scale (VAS) was used to measure pain before and after surgery as well as time until their return to previous sports level. VAS showed a mean preoperative pain score of 7.5 (SD = 0.9), whereas postoperative VAS at 1 month after surgery decreased to 0.8 (SD = 1.36). Mean symptomatic period was 8.5 months (SD = 4.3), from the beginning of symptoms up to the surgery day. Once patients had undergone surgery, mean time until their return to previous level of sports was 46.9 days (SD = 25.96), reaching the same pre-lesion Tegner level. Endoscopic treatment of posterior ankle impingement syndrome due to os trigonum showed excellent results. Hindfoot endoscopy with a posterior approach was an effective treatment and allowed for a prompt return to play in soccer players with a high activity level. Level IV, therapeutic study.

Dor no tornozelo – Um caso de Síndroma Os trigonum

Introduction: Diagnosing painful osteoarticular or musculoskeletal conditions in children and teenagers is often a challenge. Ankle pain is a frequent complaint but the Os trigonum syndrome is rarely considered. Case report: We report the case of an 18 year-old boy who complained of frequent ankle pain. Physical examination and x-ray examination were inconclusive, without remarkable changes. However, the persistence of complaints and the history of an injury led to CT scanning, which revealed an Os trigonum. Comment: This article presents the differential diagnosis of posterior ankle pain and focuses on the Os trigonum Syndrome