Os Trigonum Syndrome Research Articles

Posterior ankle impingement syndrome in dancers — a short-term follow-up after operative treatment

Summary A typical disease entity in dancers is the posterior ankle impingement syndrome. After unsuccessful conservative therapy, 24 dancers with an average age of 21.9 years (16–34 years) were treated in the same way using an open surgical technique. Functional assessment of the surgical outcome was made after an average of 26.2 months (18–34 months) using a modified version of the clinical score. A very good outcome was achieved in 13 patients (54%), and a good or satisfactory outcome in five patients each (21% each). One patient (4%) had a poor outcome. The widely used term ‘os trigonum syndrome’ is not-recommended, as it is too readily associated with a therapeutically relevant pathological finding, i.e. one requiring surgical treatment. Rather, we recommend the use of the term ‘posterior ankle impingement’, in which the cause of impingement should also be stated in all cases.

Modified arthroscopic excision of the symptomatic os trigonum and release of the flexor hallucis longus tendon: Operative technique and case study

This article presents an operative technique for modified arthroscopic excision of the symptomatic os trigonum and release of the flexor hallucis longus tendon sheath. The procedure uses two stacked posterolateral subtalar joint portals, rather than the customary anterolateral and posterolateral portal combination. By visualizing the os trigonum with an arthroscope positioned in a distal portal and introducing instrumentation through a proximal portal, the ossicle may be quickly exposed and excised with minimal dissection. A case study with a 22-month follow-up and a discussion of os trigonum syndrome are included to illustrate this procedure as an alternative to open excision or traditional arthroscopic excision.

Os trigonum syndrome. Diagnosis and therapy

The os trigonum syndrome is an entity causing posterior ankle pain and occurs mostly with typical sports activities. Diagnosis and differential diagnosis are presented. Typical complaints and therapeutic procedure are demonstrated in one case. Therapy includes different non-operative methods, resistance to non-operative procedures is an indication for excision of this ossicle.

Os trigonum syndrome

The os trigonum syndrome is an entity causing posterior ankle pain and occurs mostly with typical sports activities. Diagnosis and differential diagnosis are presented. Typical complaints and therapeutic procedure are demonstrated in one case. Therapy includes different non-operative methods, resistance to non-operative procedures is an indication for excision of this ossicle.

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The etiology of chronic diseases of the ankle joint comprises a wide spectrum including chronic inflammatory processes and chronic degenerative, tumorous and neuropathic processes, as well as some specific syndromes based on chronic changes of the ankle joint. Of the inflammatory processes, chronic juvenile arthritis (JVC) is the most common disease. However, also Reiter disease, psoriasis or chronic monoarthritid diseases such as gout, as well as granulomatous diseases (tuberculosis, sarcoidosis) and fungal infections, may affect the ankle joint in a chronic course. Chronic degenerative changes are usually secondary due to abnormal positioning of the joint constituents or repetitive trauma. Neuropathic changes, as frequently seen in the course of diabetes, present with massive osseous destruction and malposition of the articular constituents. Chronic osseous as well as cartilaginous and synovial changes are seen in hemophilic patients. Chronic traumatic changes are represented by pigmented villonodular synovitis (PVNS), and chondromatosis, both with a predilection for the ankle joint. Due to the possibilities of magnetic resonance imaging (MRI), diagnosis of chronic ankle changes includes chronic ligamentous, tendinous and soft tissue changes. With the use of MRI, specific syndromes can be defined which particularly affect the ankle joint in a chronic way, such as the os trigonum syndrome, the anterolateral impingement syndrome and the sinus tarsi syndrome. Nevertheless, plain film radiographs are still the basic element of any investigation. MRI, however, can be potentially used as a second investigation, saving an unnecessary cascade of investigations with ultrasound and CT. The latter investigations are used only with very specific indications, for instance CT for subtle bone structures and sonography for a limited investigation of tendons or evaluation of fluid. Particularly due to the possibilities of MRI and the development of special gradient-echo imaging or high-resolution coils, the investigation of the ankle joint still offers a wide spectrum of innovation for the next years, which is particularly enforced by the increasing demand for specific diagnosis of chronic diseases in orthopedic medicine.

Posterior block of the ankle: the results of surgical treatment in dancers

Summary We report the results of surgical treatment in the management of posterior block of the ankle joint (the ‘os trigonum syndrome'). Thirty-nine patients (60 ankles), 30 female and nine male, between the ages of 12–48 years, underwent surgical excision of the impinging structure through a medial approach and were reviewed retrospectively on average 40 months postoperatively. All were either student or professional classical ballet dancers. The presenting features along with the surgical technique are described. Good to excellent results were obtained in 74% of cases overall. Although there was no correlation between duration of symptoms and eventual outcome, results were better if the surgery was performed before skeletal maturity. Surgery offers an effective solution to this often underdiagnosed problem, especially if performed early in a dancer's career.

The os trigonum syndrome: imaging features.

The os trigonum syndrome refers to symptoms produced by pathology of the lateral tubercle of the posterior talar process. Pain can be caused by disruption of the cartilaginous synchondrosis between the os trigonum and the lateral talar tubercle as a result of repetitive microtrauma and chronic inflammation. Additional etiologies include trigonal process fracture, flexor hallucis longus tenosynovitis, posterior tibiotalar impingement by bone block, and intraarticular loose bodies. This pictorial essay explores the role of imaging modalities in the diagnosis and treatment of the os trigonum syndrome, a symptom complex that may present difficult diagnostic problems.

Case Study: The Painful Os Trigonum Syndrome

The painful os trigonum syndrome is one cause of posterolateral ankle pain. This syndrome is most prevalent in athletes who perform frequent and/or forceful plantar flexion. The painful os trigonum may be misdiagnosed as Achilles and/or peroneal tendinitis. In this case, the patient was misdiagnosed for 15 months and treated for tendinitis. The appropriate clinical tests to evaluate the os trigonum as a source of posterolateral ankle pain are outlined. The surgical and postoperative management for the patient are discussed. Clinicians should be aware of the painful os trigonum syndrome as a possible source of posterolateral ankle pain.

Das Os-trigonum-Syndrom

The os trigonum is one of the most frequent accessory bones of the foot. It is located dorsal of the talus. Os trigonum syndrome means a typical pain syndrome localized in the back-foot caused by this ossicle. This syndrome occurs mostly in man with sports activities accompanied with intensive stress to different parts of the foot. It can be caused particularly by standing on the toe in the "en-pointe-position" in ballet dancers when the flexor hallucis tendon is under maximal tension or by activities accompanied with maximal plan-tarflexion in soccer players for instance. Typical complaints, findings and different therapeutic procedures are demonstrated in two cases. Therapy includes different non-operative methods. Resistance to non-operative procedures is indication for operative therapy. Excision of this ossicle is surgical therapy of first choice.

Os Trigonum Syndrome: A Clinical Entity in Ballet Dancers

Thirteen Swedish National classic ballet dancers were surgically treated for an "os trigonum syndrome."Their main symptom was an impingement pain in the hind foot while actively plantarflexing the ankle during ballet dancing. The surgical procedure included excision of an os trigonum or a prominent lateral posterior process of the talus, together with division of the flexor hallucis tendon sheath if it was thickened. This procedure was safe and resulted in return of the dancers to the same level of ballet dancing within 5 to 10 weeks.

Stenosing tenosynovitis of the flexor hallucis longus tendon and posterior impingement upon the os trigonum in ballet dancers.

The problems of flexor hallucis tendonitis and os trigonum syndrome in dancers are presented. The mechanism of injury, diagnosis, treatment, and rehabilitation are outlined. Pitfalls in diagnosis are discussed as well as prognosis for return to dance class and the stage. The best surgical access to the os trigonum is a lateral approach.