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Arthroscopic Os Trigonum Resection

The os trigonum is a small extra bone attached to the talus (ankle bone) by a fibrous band of tissue at the back of the ankle. The os trigonum may go unnoticed, but sometimes causes a painful condition called os trigonum syndrome characterized by ankle pain, tenderness and swelling. This may result from an ankle injury during activities such as ballet and soccer, where the toes are repeatedly pointed downwards, causing the heel and ankle bones to compress the os trigonum. A painful os trigonum may be treated conservatively, but if symptoms persist it may have to be removed surgically.

Performing this through an open incision is often associated with complications such as infection and delayed healing. To overcome this, a minimally invasive arthroscopic procedure is performed where an arthroscope (narrow tube with a camera and light source) and miniature instruments are inserted through small incisions over the ankle to resect the os trigonum. The procedure is usually performed under general anesthesia. You are placed in a prone position with your leg adequately padded and your ankle extending over the operating table. The os trigonum is identified with the arthroscope and cut and removed by the surgical instruments, being careful not to injure important tendons, nerves and blood vessels.

Following the procedure, the incisions are sutured close and your ankle is placed in a post-operative boot for 2 weeks, allowing you to bear weight as tolerated. Range of motion exercises begin as early as 3 days postoperatively. In 2 weeks, the sutures come off and ankle strengthening exercises are recommended to return you to your regular activities.

When compared to open surgery, the arthroscopic procedure is associated with minimal complications, faster recovery, decreased morbidity and less scarring. However, as with any surgical procedure, arthroscopic os trigonum resection has a potential risk of injury to neighboring tendons, nerves and blood vessels.

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© Jessica Gallina MD, Orthopaedic Surgeon - Foot and Ankle , New York, NY
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