Keywords: Os Trigonum Syndrome, Sports, Outcomes Measures
Introduction/Purpose: Os trigonum syndrome is a common cause of posterior ankle pain in athletes performing repetitive hyper-plantarflexion of the foot, in sports such as ballet, gymnastics, and soccer. The os trigonum, an accessory bone posterior to the talus, can remain unfused or join the posterior talar process, causing pain from overuse, trauma, or impingement. When conservative management fails, surgical excision is often necessary to restore function. Prior studies report favorable outcome but are limited by small samples and few athlete-focused analyses. This study evaluates pain reduction after os trigonum excision in a large cohort of athletes, using pre- and post-operative patient-reported pain scores and the ability to return to sports following surgical treatment for os trigonum syndrome.
Methods: A retrospective chart review identified patients who underwent os trigonum excision between March 2014 and March 2024 performed by a single surgeon using posterior medial surgical approach. Inclusion criteria were athletes diagnosed with os trigonum syndrome who underwent surgical excision after failing non-operative management. Exclusion criteria were patients that had concomitant ankle procedures or lost to follow up. Athletes were defined as individuals participating in organized sports. Demographic data collected included age, sex, sport type, the ability to return to sport, patient-reported pain scores, and complications. Patient-reported pain scores were recorded preoperatively, <1 month, 6 weeks, 3 months, and >1 year postoperatively. Paired t-tests compared postoperative pain scores at each interval with corresponding preoperative values. All athletes who met the inclusion criteria were interviewed by telephone at the most recent follow-up.
Results: Thirty-three athletes were identified through chart review. Two underwent concomitant procedures and five were lost to follow-up, leaving 26 athletes included. The mean follow-up was 6.7 ± 2.8 years (range, 1.6-11.6 years). Eight patients had staged bilateral procedures. Average age at surgery was 17.5 ± 4.6 years (range, 14-35 years), and 85% were female. Sports represented included ballet (n=23), football (n=1), lacrosse (n=1), and soccer (n=1). Twenty-five of 26 athletes returned to sport without difficulty, and no patients required re-operation. Mean preoperative pain score was 3.38 ± 3.28, improving at all postoperative intervals: <1 month (1.06 ± 1.59, p<0.001), 6 weeks (0.74 ± 1.26, p<0.001), 3 months (1.60 ± 2.04, p=0.055), and >1 year (0.00 ± 0.00, p<0.001).
Conclusion: Os trigonum excision is a safe and effective treatment for athletes with symptomatic os trigonum syndrome who failed conservative management. This procedure is successful with pain resolution on a long- term basis and has a high rate of return-to-sport in athletes.
