achilles tendon injury -

Os trigonum

 

achilles tendon injury -

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.

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.

achilles tendon injury -

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

achilles tendon injury -

Diagnosis of Os trigonum in runners

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 your specialist about 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.

achilles tendon injury -

Treatment: Non-surgical Approaches

Relief of the symptoms is often achieved through treatments that can include a combination of the following:

P - R - I - C - E

Protection - Your ankle may be splinted, taped or braced to prevent further injury.
Rest - You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping.
	Ice - Place a plastic bag with ice on the Achilles for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications.
	Compression - Wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold.
Elevate - Make sure to elevate the ankle above heart level (hip level is acceptable during class).

 

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.

 

orthotics. If the biomechanics of the foot is faulty it will contribute to mechanical stress behind the heel increasing the chances of irritation from the boney growth. Orthotics can control these unwanted mechanical forces and significantly improve symptoms. A specialist called a podiatrist can help with provision of orthotics.

If the condition is severe. Immobilisation of the ankle may help, particularly when partaking in strenuous activity.

 

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.