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Os trigonum identified after trauma to heel

  • Mackenzie E. Pargeon and Lindsay R. Tjiattas-Saleski ORCID logo EMAIL logo
Published/Copyright: March 2, 2022
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 122 Issue 5

A 47-year-old man presented to the Emergency Department in November 2021 with right foot pain and difficulty walking. The patient had undergone trauma to the right ankle after a cut tree trunk snapped back and hit his posterior heel. He presented the next day after developing mild pain in the right lateral midfoot and pain with ambulation. He had full range of motion of the ankle and foot without difficulty. There were no open wounds. There was no tenderness to palpation over the Achilles tendon, and the patient was able to fully dorsiflex and plantarflex the foot. There was some mild tenderness to palpation in the proximal, dorsal midfoot with mild associated swelling. The patient had no prior history of injuries or pain in the ankle. Oblique and lateral right ankle X-rays were obtained and demonstrated the accessory bone (Figure 1), and the patient was diagnosed with an os trigonum.

Figure 1: (A) X-ray of the patient’s right ankle (oblique view). (B) X-ray of the patient’s right ankle (lateral view).
Figure 1:

(A) X-ray of the patient’s right ankle (oblique view). (B) X-ray of the patient’s right ankle (lateral view).

An os trigonum is an accessory bone on the posterior ankle that occurs when a portion of the talus does not fuse completely with the rest of the bone during development [1], [2], [3], [4], [5], [6]. An os trigonum can occur in up to 49% of people and is usually unilateral [1, 3, 4, 6]. It is typically asymptomatic [2]. Os trigonum syndrome can develop when a previously asymptomatic os trigonum is acutely injured (for example, due to an ankle sprain, causing inflammation and pain) [1, 2]. It can also become symptomatic due to overuse and irritation injuries, which occur progressively in athletes like dancers or kickers who repetitively plantarflex the foot [1], [2], [3, 5, 6]. This frequent flexion can compress the os trigonum, leading to flexor hallucis longus (FHL) tendinitis, and pain can also worsen when pressure is placed on the big toe or when the foot is plantar flexed [1], [2], [3, 5, 6]. In addition to pain of the posterior ankle, patients may also notice tenderness and swelling to the area [1], [2], [3]. Imaging typically begins with an X-ray, but CT and MRI can also be used to rule out other possible causes of a patient’s pain [2, 3, 6]. Os trigonum syndrome treatment begins with conservative management including immobilization, rest, ice, anti-inflammatory medications, stretching, or OMT directed at the FHL, and possibly steroid injections [1], [2], [3, 6]. If several months of conservative management does not relieve the patient’s symptoms, then surgical removal of the os trigonum can be considered [1], [2], [3, 5, 6].

Corresponding author: Lindsay R. Tjiattas-Saleski, DO, MBA, Emergency Medicine Physician, St. Luke’s Emergency Department, Columbus, NC, USA; and Associate Dean of Clinical Affairs, Department of Clinical Affairs, Edward Via College of Osteopathic Medicine-Carolinas Campus, 350 Howard Street, Spartanburg, SC 29303-3515, USA, E-mail:

  1. Research funding: None reported.

  2. Author contributions: Both authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; both authors drafted the article or revised it critically for important intellectual content; both authors gave final approval of the version of the article to be published; and both authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  3. Competing interests: None reported.

References

1. Bariteau, J. Os Trigonum Syndrome. FootCareMD. American Orthopaedic Foot and Ankle Society. Available from: https://www.footcaremd.org/conditions-treatments/ankle/os-trigonum-syndrome.Search in Google Scholar

2. Os Trigonum Syndrome. Foot health facts. American College of Foot and Ankle Surgeons. Available from: https://www.foothealthfacts.org/conditions/os-trigonum-syndrome.Search in Google Scholar

3. Os Trigonum Syndrome. SportsMedicineToday. American Medical Society for Sports Medicine. Available from: https://www.sportsmedtoday.com/os-trigonum-syndrome-va-251.htm.Search in Google Scholar

4. Jones, J. Os trigonum. Reference article, Radiopaedia.org. Available from: https://doi.org/10.53347/rID-10194.10.53347/rID-10194Search in Google Scholar

5. Coughlin, MJ, Saltzman, CL, Anderson, RB, eds. Sesamoids and accessroy bones of the foot. In Mann’s surgery of the foot and ankle, 9th ed. Philadelphia, PA: Saunders/Elsevier; 2014.Search in Google Scholar

6. Rungprai, C, Tennant, JN, Phisitkul, P. Disorders of the flexor hallucis longus and os trigonum. Clin Sports Med 2015;34:741–59. https://doi.org/10.1016/j.csm.2015.06.005.Search in Google Scholar
Received: 2021-11-16
Accepted: 2022-01-27
Published Online: 2022-03-02

© 2022 Mackenzie E. Pargeon and Lindsay R. Tjiattas-Saleski, published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/jom-2021-0270
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Articles in the same Issue

  1. Frontmatter
  2. General
  3. Original Article
  4. Assessing the United States’ most frequently asked questions about osteopathic medicine, osteopathic education, and osteopathic manipulative treatment
  5. Medical Education
  6. Brief Report
  7. Parental leave in medical school: supporting students as parents
  8. Musculoskeletal Medicine and Pain
  9. Clinical Practice
  10. Osteopathic approach to sacroiliac joint pain in pregnant patients
  11. Neuromusculoskeletal Medicine (OMT)
  12. Original Article
  13. Effects of osteopathic manipulative treatment vs. osteopathic cranial manipulative medicine on Parkinsonian gait
  14. Obstetrics and Gynecology
  15. Review Article
  16. Upgrade rate of percutaneously diagnosed pure flat epithelial atypia: systematic review and meta-analysis of 1,924 lesions
  17. Public Health and Primary Care
  18. Brief Report
  19. Primary care providers’ experiences treating low back pain
  20. Clinical Image
  21. Os trigonum identified after trauma to heel
  22. Letter to the Editor
  23. Cost of medical student virtual conference registration in ophthalmology and urology during the COVID-19 pandemic
  24. AOA Communications
  25. Proposed Amendments to the AOA Constitution
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