Case Study: Persistent Ankle Pain—The Os Trigonum Duly Considered

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.

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Posterior Block of the Ankle Joint in Dancers

Foot & Ankle ◽

10.1177/107110078200300205 ◽

1982 ◽

Vol 3 (2) ◽

pp. 81-84 ◽

Cited By ~ 67

Author(s):

A.J.G. Howse

Keyword(s):

Ankle Joint ◽

Posterior Part ◽

Ankle Pain ◽

Os Calcis ◽

Os Trigonum ◽

Presenting Symptoms ◽

Plantar Aspect ◽

After Care ◽

Achilles Tendonitis

A posterior block of the ankle joint caused by an os trigonum, a large posterior tubercle of the talus, or prominence on the dorsum of the posterior part of the os calcis is described. The presenting symptoms are listed, the most important being Achilles tendonitis anterolateral ankle pain, recurrent calf strain, and pain under the plantar aspect of the foot. All these can be associated with difficulty in pointing the foot. Details are given of the operation and the after care.

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The os trigonum syndrome. A literature review

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-82-3-154 ◽

1992 ◽

Vol 82 (3) ◽

pp. 154-161 ◽

Cited By ~ 30

Author(s):

RL Blake ◽

PJ Lallas ◽

H Ferguson

Keyword(s):

Literature Review ◽

Recent Literature ◽

Ankle Pain ◽

Os Trigonum

The os trigonum syndrome, a musculoskeletal ankle disorder causing posterior ankle pain, is an entity that may present as numerous disorders. To accurately diagnose and treat the syndrome, its anatomy, origin, nomenclature, and biomechanics must be thoroughly understood. For this purpose, a review of recent literature is presented.

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Case Study: The Painful Os Trigonum Syndrome

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.1995.22.1.22 ◽

1995 ◽

Vol 22 (1) ◽

pp. 22-25 ◽

Cited By ~ 8

Author(s):

Glenn P. Brown ◽

Raymond V. Feehery ◽

Steven M. Grant

Keyword(s):

Os Trigonum

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Painful Medial Ankle in a Young Dancer: A Case Report of a Symptomatic Secondary Ossification Center of the Medial Malleolus

Journal of Dance Medicine & Science ◽

10.12678/1089-313x.24.1.44 ◽

2020 ◽

Vol 24 (1) ◽

pp. 44-46

Author(s):

Mandy Zhang ◽

Yue Shuen Wong

Keyword(s):

Case Report ◽

Ossification Center ◽

Medial Malleolus ◽

Skeletally Immature ◽

Ankle Pain ◽

Dance Class ◽

Extreme Loads ◽

Immature Individual ◽

Secondary Ossification Center

An osseous fragment at the distal tip of the medial malleolus in a skeletally immature individual may represent a secondary ossification center and should not always be interpreted as a fracture. In this case study of a young dance student presenting with bilateral medial ankle pain, we postulated that hindfoot valgus, in combination with extreme loads placed on the foot during ballet training, increased stresses at the medial malleolus and accessory physis. Our patient was treated conservatively for symptomatic secondary ossification of medial malleolus and she returned to dance class at 6 months.

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Exorotated radiographic views have additional diagnostic value in detecting an osseous impediment in patients with posterior ankle impingement

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2019-000272 ◽

2019 ◽

Vol 4 (4) ◽

pp. 181-187

Author(s):

Ruben Zwiers ◽

Johannes G G Dobbe ◽

Geert J Streekstra ◽

Leendert Blankevoort ◽

Johannes I Wiegerinck ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Interobserver Reliability ◽

Diagnostic Value ◽

Lateral View ◽

Ct Scans ◽

Ankle Pain ◽

Os Trigonum ◽

Ankle Impingement ◽

Posterior Ankle Impingement ◽

Projection Angle

ObjectivesA standard lateral radiograph is the first step in the diagnostic workup in patients with posterior ankle pain. Because of overprojection by other structures at suboptimal radiographic projection angle, often an os trigonum is not discovered or erroneously be mistaken for a hypertrophic posterior talar process. The aim of this study was to identify the projection angles at which a radiograph is optimal for detecting bony impediments in patients suffering from posterior ankle impingement.MethodsUsing ankle CT scans of patients with posterior ankle impingement, digitally reconstructed radiographs (DRRs) simulating 13 different radiographic projection angles were generated. The ankle CT scans served as a reference for the detection of an os trigonum and hypertrophic posterior talar process. Members of the Ankleplatform Study Group were invited to assess the DRRs, for presence or absence of an os trigonum or hypertrophic posterior talar process. Diagnostic accuracy and interobserver reliability were estimated for each projection angle. In addition, the diagnostic accuracy of the standard lateral view in combination with the rotated views was calculated.ResultsHigh sensitivity for detecting an os trigonum was found for +15° (90.3%), +20° (81.7%) and +25° (89.7%) degrees of exorotation. Specificity in this range of projection angles was between 89.6% and 97.8%. Regarding the presence of a hypertrophic posterior talar process, increased sensitivity was found for +15° (65.7%), +20° (61.0%), +25° (60.7%), +30° (56.3%) and +35° (54.5%). Specificity ranged from 78.0% to 94.7%. The combination of the standard lateral view in combination with exorotated views showed higher sensitivity. For detecting an os trigonum, a negative predictive value of 94.6% (+15°), 94.1% (+20°) and 96.1% (+25°) was found.ConclusionThis study underlines the additional diagnostic value of exorotated views instead of, or in addition to the standard lateral view in detecting an osseous impediment. We recommend to use the 25° exorotated view in combination with the routine standard lateral ankle view in the workup of patients with posterior ankle pain.Level of evidenceLevel III

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Managing Psoriatic Arthritis With a Whole Food Plant-Based Diet: A Case Study

American Journal of Lifestyle Medicine ◽

10.1177/1559827621993435 ◽

2021 ◽

pp. 155982762199343

Author(s):

Marta Lewandowska ◽

Kate Dunbar ◽

Shireen Kassam

Keyword(s):

Case Report ◽

Psoriatic Arthritis ◽

Food Plant ◽

Female Teacher ◽

Ankle Pain ◽

Rheumatology Clinic ◽

Disease Remission ◽

Diet And Lifestyle ◽

Added Salt

A 40-year-old female teacher presented to the rheumatology clinic in 2003 with nonspecific back, knees, and right ankle pain. She was subsequently diagnosed with psoriatic arthritis and was taking methotrexate to control her disease. Over the years, her symptoms were mostly under control. However, in 2018, after adopting a whole food plant-based diet free of added salt, oil, and sugar, she was able to stop taking methotrexate. She was discharged from the rheumatology clinic and has remained symptom-free since. The available literature on managing psoriatic arthritis with diet shows that less than 2% of patients with psoriatic arthritis are able to discontinue medication as a result of disease remission. This case report adds to support and encourages further research in the field of managing inflammatory polyarthropathies with diet and lifestyle.

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