Os trigonum impingement in dancers

Abstract

Sixteen patients underwent surgical excision of an im pinging ossicle through a posterior lateral approach. Twelve of these patients (15 ankles) were available for followup and were retrospectively surveyed at an av erage of 28 months after surgery. There were 9 women and 3 men. Nine were professional ballet dancers and 3 were students of advanced ballet schools. Preoper ative symptoms included pain localized to the posterior ankle, limitation of motion, weakness, swelling, or neu rologic changes associated with dance activities. All patients were severely hampered in their dance partic ipation and had failed nonsurgical therapies. Postoperatively, all patients followed an aggressive rehabilitation protocol. All had improvement in their impingement symptoms; eight (67%) still had occa sional discomfort. All professional dancers returned to unrestricted dance activity. The mean time to full activity was 3 months. One patient had a superficial wound infection requiring antibiotic treatment and another suf fered a transient tibial nerve neurapraxia. Both of these complications resolved without sequelae. We conclude that posterior ankle impingement in ballet dancers, caused by an os trigonum and resistant to nonsurgical therapies, is effectively treated with sim ple excision of the offending structure.