OCAD MSK

History

29M competitive weight lifter w onset ankle and foot pain mid August and flattening of the arch

Figure 1 for case os trigonum — Figure 1

Figure 2 for case os trigonum — Figure 2

Figure 3 for case os trigonum — Figure 3

Figure 4 for case os trigonum — Figure 4

Discussion

The 4th slide showed a partial longitudinal split of the inframalleolar PTT superimposed on tendinosis. The underlying tendinosis is likely chronic given the pressure erosion of the posterior med malleolus (where there is reactive marrow edema). See the red arrows in slides 1+2. Is this a multi-partite os trigonum? Have you ever seen that? Could it instead be chronic Shepherd fracture? There is posterior ankle and subtalar synovitis, which might be related to posterior ankle impingement (though the main symptoms are of PTTD).

Diagnosis

os trigonum

Hilary Umans, MD

Courtesy

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