Acute Phase
Physical Therapy
The initial treatment of ankle impingement syndrome includes nonsteroidal antiinflammatory drugs (NSAIDs) as needed for pain, physical therapy, bracing, and orthotics.
Surgical Intervention
With the failure of conservative modalities, surgical intervention is indicated. Arthroscopic excision and debridement is the treatment of choice. [15, 16, 17, 18, 19, 20, 21]
A study by Georgiannos et al reported lower complication rates and shorter return to full activities with endoscopic excision of the os trigonum compared to the open procedure. [22]
Other Treatment
Occasionally, steroid injection into the affected area may give relief. Intra-articular anesthetic (lidocaine) ankle injection can be used as a differential tool to distinguish between ankle pain and subtalar pain.
Electrotherapeutic modalities may also be helpful.
In ballet dancers, technique assessment is helpful and essential to prevent further pain and injury.
Recovery Phase
Rehabilitation Program
Physical Therapy
Postoperatively, advise posterior splinting for 1 week, as well as a supportive brace and elastic compression stocking. Physical therapy is initiated at 2-3 weeks for strengthening, range of motion, proprioception, and sport-specific rehabilitation.
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Radiograph of an os trigonum in a ballet dancer. Image courtesy of Dr. Craig Young.
