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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
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.
UPDATE 3/23/20: In attempt to maintain the safety of our patients, employees, and the community, the office is physically closed, other than for the care of patients with urgent concerns / emergenices only. Attempts will be made to return phone calls Monday through Thursday from 9AM to 1PM. Please use the "Request an Appointment" resource above to request an appointment. If an established patient, we encourage you to log into the Patient Portal and send a message to Dr. Barnes or the office with any questions or concerns. Thank you.
TeleHealth and Tele-Visits in the time of COVID-19
Step Ahead Foot & Ankle Clinic, PC has initiated a TeleHealth Service during the COVID-19 Pandemic for a number of reasons:
1.) Our top priority has always been, and continues to be, Patient, Employee, Community Health and Safety.
2.) With the primary goal of triaging, or prioritizing what's urgent and what's not, Dr. Barnes seeks to help patients with the foot concerns over the phone or computer. Caring for patients in this way, and arranging for visits in clinic if necessary (infections, ulcerations, injuries) and in a controlled environment, she hopes to do her part in allowing to the Urgent Cares and Emergencies Rooms help those with needs related to the virus.
3.) Although Dr. Barnes obviously cannot physicially treat you or other patients over the phone or computer, she can hopefully see if your concern would be best treated physically, and arrange for this to be done. If she can help give you direction and advice over the computer or phone, she will do so. This particularly applies to you if you have foot pain, as many treatment options can be relayed in this way (stretches, shoe recommendations, orthotic recommendations).
4.) During this time of anxiety, stress, and uncertainty, Dr. Barnes wants to do her part in helping you do the things you need to do (caring for a loved one, running outside for stress relief, or walking on a treadmill at home, for example) without foot pain interfering. She does't want you to have to wait months or an indefinite period of time for you to get back on your feet! "CLICK HERE TO REQUEST A TELEVISIT."