Bilateral Os Trigonum Syndrome Associated with Bilateral Tenosynovitis of the Flexor Hallucis Longus Muscle

Üzel, Murat; Cetinus, Ercan; Bilgic, Erkal; Karaoguz, Ahmet; Kanber, Yonca

doi:10.1177/107110070502601017

Cited by 19 publications

(15 citation statements)

References 11 publications

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“…9,17 Because of the high incidence of concurrent FHL tendinopathy with os trigonum syndrome in dancers, we believe the FHL tendon should always be inspected intraoperatively. 16,17,36,43,45,49,54 The FHL tendon is difficult to assess and release via the posterolateral approach, because the tendon lies deep within the operative exposure. 17 It is the authors' belief and experience that persistent posterior/posteromedial pain in a dancer who has undergone complete excision of an os trigonum via a posterolateral approach is often due to unaddressed FHL tendon or tendon sheath pathology.…”

Section: Discussionmentioning

confidence: 99%

“…Flexor hallucis longus (FHL) tendonitis, also known as “dancer’s tendonitis,” has been reported to occur in 63% to 85% of cases of os trigonum syndrome. 16,17,43,45,49,54 The FHL tendon runs in the groove between the medial and lateral tubercles of the posterior talus through a fibro-osseous tunnel behind the medial malleolus. 9,43,45 During repetitive dorsiflexion of the first metatarsophalangeal joint and plantarflexion of the ankle, as occurs with releve in demipointe position in ballet, the tendon is pulled into the tunnel, which can result in tendonitis, tenosynovitis, and occasional “triggering.” 1,9,17,18,21,23,24,43…”

Section: Introductionmentioning

confidence: 99%

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Os Trigonum Excision in Dancers via an Open Posteromedial Approach

Heyer

Rose

2016

Foot Ankle Int.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Os Trigonum Excision in Dancers via an Open Posteromedial Approach

Heyer

Rose

2016

Foot Ankle Int.

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“…Secondary treatment options are open or arthroscopic excision of the os trigonum with release of the FHL tendon. Open surgery for the os trigonum associated with tenosynovitis of the FHL has been Case Reports in Orthopedics reported [15]. However, arthroscopic approaches have gained popularity in the past decade because they produce less scarring and are associated with less postoperative pain, minimal overall morbidity, and an earlier return to daily activity.…”

Section: Discussionmentioning

confidence: 99%

Posterior Arthroscopic Treatment of a Massive Effusion in the Flexor Hallucis Longus Tendon Sheath Associated with Stenosing Tenosynovitis and Os Trigonum

Tonogai

Sairyo

2020

Case Reports in Orthopedics

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We report a rare case of massive accumulation of fluid in the flexor hallucis longus tendon sheath with stenosing tenosynovitis and os trigonum. A 34-year-old woman presented to our hospital with pain and swelling in the posteromedial aspect of the left ankle joint after an ankle sprain approximately 8 months earlier. There was tenderness at the posteromedial aspect of the ankle, and the pain worsened on dorsiflexion of the left great toe. Magnetic resonance imaging revealed massive accumulation of fluid around the flexor hallucis longus tendon. We removed the os trigonum, performed tenosynovectomy around the flexor hallucis longus, and released the flexor hallucis longus tendon via posterior arthroscopy using standard posterolateral and posteromedial portals. At 1 week postoperatively, the patient was asymptomatic and able to resume her daily activities. There has been no recurrence of the massive accumulation of fluid around the flexor hallucis longus tendon as of 1 year after the surgery. To our knowledge, this is a rare case report of extreme massive effusion in the flexor hallucis longus tendon sheath with stenosing tenosynovitis and os trigonum treated successfully by removal of the os trigonum, tenosynovectomy around the flexor hallucis longus, and release of the flexor hallucis longus tendon via posterior ankle arthroscopy.

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“…41 In the setting of concomitant FHL tenosynovitis, patients may report episodes of the ankle giving way, triggering of the hallux, pain on palpation of the posteromedial ankle between the Achilles tendon and the medial malleolus, or pain over the FHL tendon at the level of the ankle/hindfoot with active contraction or passive stretching. 41 Routine ankle radiographs may suggest posterior osteophytes, a large Stieda process, or os trigonum. In cases of ankle trauma, to diagnose a Stieda process or an OT acute fracture, a CT scan can be helpful to look for multiple fragments and hidden posterior pathology.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Posterior Ankle Impingement Secondary to Os Trigonum in Recreational Athletes

Nikolopoulos¹,

Safos²,

Μουστάκας³

et al. 2020

Foot & Ankle Orthopaedics

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Background: The os trigonum (OT)—the most common accessory bone of the foot—although usually asymptomatic, may cause posterior ankle impingement syndrome (PAIS), which may be a severely debilitating problem for recreational or competitive athletes. The aim of the present study was to evaluate effectiveness of posterior ankle arthroscopy and to assess the outcome in the treatment of PAIS secondary to OT impingement or OT fractures within a group of young athletes and their return to previous sports level. Methods: From 2011 to 2018, a retrospective review of 81 recreational athletes of mean age 27.8 years was performed. All patients were diagnosed with PAIS due to OT pathology and were operated on endoscopically with resection of the OT. Pre- and postoperative clinical evaluation were performed at 3 months, 1 year, and 2 years based on visual analog scale (VAS), ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, and the Foot & Ankle Disability Index (FADI) scores, in a follow-up of at least 2 years. Results: VAS score was significantly improved from an average of 7.5 (5-9) preoperatively to 1.9 (1-3) at 3 months postoperatively and to 0.6 (0-2) and 0.3 (0 -1) at 1 and 2 years postoperatively. Ankle ROM was significantly improved from an average of 24.8 (10-35) preoperatively to 58.0 (50-65) at 3 months postoperatively and to 64.0 (50-65) at 1 year and 64.7 (60-65) at 2 years postoperatively. AOFAS and FADI scores were significantly improved from 39.4 (18-55) and 49.7 (42.3-62.5) preoperatively to 85.2 (74-89) and 87.3 (81.7-88.5) postoperatively at 3 months to 97.7 (85-100) and 97.9 (93.3-100) postoperatively at 1 year, respectively ( P < .001). Only 5 patients dropped to a lower activity level. There were 5 complications (4 transient). Conclusion: Endoscopic treatment of PAIS due to OT pathology demonstrated excellent results. Posterior ankle arthroscopy was an effective treatment and allowed for a prompt return to a high activity level of their athletic performance. Level of Evidence: Level IV, therapeutic study / retrospective case series.

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Bilateral Os Trigonum Syndrome Associated with Bilateral Tenosynovitis of the Flexor Hallucis Longus Muscle

Cited by 19 publications

References 11 publications

Os Trigonum Excision in Dancers via an Open Posteromedial Approach

Os Trigonum Excision in Dancers via an Open Posteromedial Approach

Posterior Arthroscopic Treatment of a Massive Effusion in the Flexor Hallucis Longus Tendon Sheath Associated with Stenosing Tenosynovitis and Os Trigonum

Endoscopic Treatment of Posterior Ankle Impingement Secondary to Os Trigonum in Recreational Athletes

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