Os Trigonum Syndrome
![OsTrig]()
What is
the Os Trigonum?
The os trigonum is an extra (accessory) bone that sometimes develops behind the
ankle bone (talus). It is connected to the talus by a fibrous band. The
presence of an os trigonum in one or both feet is congenital (present at
birth). It becomes evident during adolescence when one area of the talus does
not fuse with the rest of the bone, creating a small extra bone. Only a small
number of people have this extra bone.
What is Os Trigonum Syndrome?
Often,
people don’t know they have an os trigonum if it hasn’t caused any problems.
However, some people with this extra bone develop a painful condition known as
os trigonum syndrome.
Os trigonum syndrome is usually triggered by an injury, such
as an ankle sprain. The syndrome is also frequently caused by repeated downward
pointing of the toes, which is common among ballet dancers, soccer players and
other athletes.
For the person who has an os trigonum, pointing the toes
downward can result in a “nutcracker injury.” Like an almond in a nutcracker,
the os trigonum is crunched between the ankle and heel bones. As the os
trigonum pulls loose, the tissue connecting it to the talus is stretched or
torn and the area becomes inflamed.
Signs and Symptoms of Os Trigonum
Syndrome
The signs and symptoms of os trigonum syndrome may include:
- Deep,
aching pain in the back of the ankle, occurring mostly when pushing off on
the big toe (as in walking) or when pointing the toes downward
- Tenderness
in the area when touched
- Swelling
in the back of the ankle
Diagnosis
Os trigonum syndrome can mimic other conditions such as an Achilles tendon injury,
ankle sprain, or talus fracture. Diagnosis of os trigonum syndrome begins with
questions from the doctor about the development of the symptoms. After the foot
and ankle are examined, x-rays or other imaging tests are often ordered to
assist in making the diagnosis.
Treatment:
Non-surgical Approaches
Relief of the symptoms is often achieved through treatments that can include a
combination of the following:
- Rest.
It is important to stay off the injured foot to let the inflammation
subside.
- Immobilization.
Often a walking boot is used to restrict ankle motion and allow the
injured tissue to heal.
- Ice.
Swelling is decreased by applying a bag of ice covered with a thin towel
to the affected area. Do not put ice directly against the skin.
- Oral
medication. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen, may be helpful in reducing the pain and inflammation.
- Injections.
Sometimes cortisone is injected into the area to reduce the inflammation
and pain.
When is
Surgery Needed?
Most patients’ symptoms improve with non-surgical treatment. However, in
some patients, surgery may be required to relieve the symptoms. Surgery
typically involves removal of the os trigonum, as this extra bone is not
necessary for normal foot function.
Information provided by The American College of Foot and Ankle Surgeons