1999KC os tri

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Information about 1999KC os tri

Published on July 9, 2007

Author: Mentor

Source: authorstream.com

Acute Posterior Ankle Pain in a High School Football Player:  Acute Posterior Ankle Pain in a High School Football Player Stuart Freed, MD Dale Blair, MS, CSCS, ATC Andrew Behler Adam Noble Allen Noble Wenatchee High School Wenatchee, Washington Personal Data/History:  Personal Data/History A 16 y/o male varsity football player c/o acute postero-medial pain in the right ankle. The athlete was cutting on a plantar flexed foot, felt a pop, and then experienced immediate pain. The athlete continued to compete with discomfort. Physical Signs and Symptoms:  Physical Signs and Symptoms The athlete presented with exquisite tenderness on palpation of postero- medial aspect of the talus and medial malleolus No tenderness was present over the lateral aspect of the ankle Full ROM w/ pain in terminal plantar flexion Past History:  Past History Athlete had fractured his os trigonum on the contralateral ankle in a non-sports related injury approximately one month earlier. Physical Signs and Symptoms:  Physical Signs and Symptoms No instability with ligament laxity tests Manual muscle tests (especially DF and PF) were limited by pain. A biomechanical evaluation revealed a forefoot varus. Differential Diagnoses:  Differential Diagnoses Achilles tendon strain Flexor hallucis longus strain Tibialis posterior strain Deltoid ligament (post. tibio-talar) sprain Os trigonum fx Osteochondral lesion of talus Posterior tibio-talar impingement Posterior talo-calcaneal ligament avulsion Diagnostic Imaging/ Laboratory Tests:  Diagnostic Imaging/ Laboratory Tests X-rays revealed a complete fracture of the os trigonum of the talus. Clinical Course:  Clinical Course A course of conservative management including walking boot immobilization for the ankle (neutral position) for three weeks. Following the removal of the walking boot, he performed pool workouts progressing to running and cutting. Clinical Course:  Clinical Course Athlete was fitted with orthotics to correct his forefoot varus. He was also given stretching and strengthening exercises with emphasis on his posterior ankle/calf musculature Discussion:  Discussion Os trigonum =Accessory bone found just posterior to talus Present in 50% of normal feet It may fuse w/ lateral tubercule or remain as separate ossicle Os trigonum is round, oval, or triangular and of variable size It may be considered a non-united portion of the lateral tubercle. Deviated From Expected:  Deviated From Expected The os trigonum is a 'normal variant' of bony ankle anatomy The os trigonum fracture can be easily confused with other posterior pathologies. Lateral x-rays to confirm diagnosis; Continuing pain w/ neg. x-ray, a bone scan may be a useful evaluative test. Thank you:  Thank you

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