Os trigonum in adolescent

Posterior Ankle Pathology

Description of patient (type of occupation, indication of age, intensity of sport):

13 year old girl. High level competitive gymnastics

History and previous treatment:

Since 1 year anterior and posterior ankle pain.
She had an ankle distorsion during sports 1 year ago and never was painfree after.

Current complaints:

Now presenting with anterior and posterior ankle pain
Since 2 months she stopped gymnastics, but she still has pain during walking and even in rest.

Physical examination:

Little swelling of the ankle
normal alignment
Pain on palpation of the anterior tibiotalar joint
posterior impingement test is painful
Dorsiflexion of the ankle is painful
dorsiflexion of the hallux is not painful

Case summary:

13 year old high level gymnast girl with anterior and posterior ankle pain and small os trigonum.
Cannot perform sport anymore

Question(s) to this case:

Treat her like adult ? Posterior arthroscopy and removal of os trigonum ?
Anterior injection with steroid first ?


Yes I would treat her as an adult. Posterior ankle pain now for >1 year. Posterior ankle arthroscopy with removal of os trigonum. I would expect the ant ankle pain to resolve with time (= rehab time for the posterior surgery)