Surgical Outcomes of Os Trigonum Syndrome in Dancers: A Case Series

Abstract

Background: Management of ankle pain in dancers can be challenging because of the repetitive stress and complex demands placed on this region. Despite the prevalence of ankle injuries in this population, literature on surgical outcomes and return to dance is limited. Purpose: To retrospectively evaluate the efficacy and functional outcomes after surgical excision of a symptomatic os trigonum in dancers. Study Design: Case series; Level of evidence, 4. Methods: Between June 2006 and June 2016, a total of 44 dancers underwent surgical excision of a symptomatic os trigonum at a single institution and by a single surgeon. All patients presented with symptoms of posterior ankle impingement syndrome and subsequently failed nonsurgical treatment. Clinical analysis was conducted using various pre- and postoperative patient-reported outcome questionnaires, including the Veterans RAND 12-Item Health Survey (VR-12), Foot Function Index–Revised (FFI-R), and visual analog scale (VAS) for pain, as well as subjective patient satisfaction. Results: A total of 44 patients (54 ankles; mean age, 18.2 years) were retrospectively evaluated at a mean follow-up of 33.4 months. The VR-12 Physical Health score improved from a mean score of 37.8 ± 11.9 to 51.2 ± 10.5 ( P < .001). The cumulative FFI-R score improved from 46.45 ± 13.8 to 31.2 ± 9.7 ( P = .044), with the subcategory of “activity limitation” representing the highest-scoring FFI-R subcategory at 65.28 ± 13.4 preoperatively and improving to 34.47 ± 12.4 at follow-up ( P < .001). The mean VAS score for subjective pain improved significantly from 5.39 ± 2.84 to 1.73 ± 2.10 ( P < .00044). Conclusion: Overall, the findings of the present study demonstrate that dancers of varying style and level improved significantly according to various clinical measures. Patients included in this study reported that they returned to their previous level of dance upon completion of physical therapy and maintained thriving postoperative careers, which for several meant dancing at the professional level.

Five-year follow-up of endoscopic resection of symptomatic os trigonum: a prospective interventional cohort study of a possible cause of ankle and big toe pain

“…This population of patients covered a broader spectrum of sport and occupational activities than those who previously have been presented in the literature, which included only dancers and athletes such as swimmers, tennis, or soccer players. [1][2][3]7,11,14,23 Treatment of symptomatic os trigonum syndrome usually starts conservatively with NSAIDs, physical therapy, and activity modification. 4,24 Therefore, all patients continued conservative therapy for 6 mo.…”

“…Pain and function significantly improved at final follow-up with no major complications. This population of patients covered a broader spectrum of sport and occupational activities than those who previously have been presented in the literature, which included only dancers and athletes such as swimmers, tennis, or soccer players 1–3,7,11,14,23…”

“…O s trigonum syndrome is one of the posterior ankle impingement syndromes (PAIS) that is misdiagnosed frequently as peroneal tendinitis in athletes with posterolateral ankle pain. 1 Os trigonum represents a pathologic variant of the posterolateral talar process resulting from repetitive forceful plantar flexion that commonly affects dancers 2,3 and athletes because of a push-off maneuver (i.e., kicking, downhill running, basketball, soccer and jumping). 4,5 The pain and tenderness are located anterior to the Achilles tendon, and symptoms are increased by forced plantar flexion of the foot.…”

Is anterior and posterior ankle impingement under-diagnosed? A review

“…Additional X-ray views are carried out in ankle plantar-flexion. [40] MRI helps confirm diagnosis and excludes any other pathology in posterior ankle like a cyst or a low lying FHL muscle belly. T2-weighted image shows bone edema, synchondrosis, and soft-tissue signal changes [Figure 3].…”

“…Major cause of impingement posteriorly is bony and arises due to two very related pathologies which are the "Os trigonum" and stieda process. [40] A secondary ossification center forms at the posterolateral aspect of talus and usually fuses with the posterior talus in adolescence, if this fusion creates a large posterolateral talar process, it is called the stieda process. [41] However, if the same fails to fuse, an os trigonum is formed, which articulates with the talus through a synchondrosis (7-14% cases).…”