Os-Trigonum Syndrome

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Patient Information

https://physioworks.com.au/injuries-conditions-1/posterior-ankle-impingement

GP Information

Background Information

  • An Os trigonum is a congenital accessory bone behind the talus that is classically asymptomatic
  • Symptoms may occur following forced or repetitive plantar flexion causing stretching or tearing of the connecting soft tissue, or even fracture.
  • DDx include Achilles pathology or talus fracture
  • Patients typically complain of pain pain in the back of the ankle, worse on push off and plantarflexion.
  • Examination may reveal localised tenderness or swelling.

Investigation Guidelines

  • Diagnosis may be confirmed with plain radiographs.

Management Recommendations

Treatment is normally conservative

  • Prescribe PRICE
  • Short term NSAIDs
  • Steroid injections are appropriate if skilled with a confirmed diagnosis.
  • Physiotherapy for stretching exercises.

Referral Indications

  • Diagnostic uncertainty
  • Failure of conservative measures after a minimum of 3months
  • Referral for formal physiotherapy
  • Referral for steroid injection or arthroscopic or open excision.