Os Trigonum Syndrome in a High School Football Lineman

Os Trigonum Syndrome in a High School Football Lineman

During pre-season football practice a 15 year old, freshman, football lineman (mass 95.5kg, height 172.7cm) reported to the athletic training room complaining of right ankle/lower leg pain. Upon evaluation, the athlete reported generalized pain over the distal tibia and fibula, with isolated symptoms over the posterior calcaneous. The athlete reported insidious onset of pain, which was a 7/10 at rest and 9/10 during activity. No swelling/edema, deformity, tenderness, ecchymmosis or crepitus was evident and soft tissue and bony palpation was unremarkable. Fracture and ligamentous stress tests were normal; athlete presented with functional pes planus. Athlete was referred for X-rays and MRI, which indicated the presence of a fracture of Steida’s process and evidence of a calcaneal bone contusion. The athlete opted for a non-operative rehabilitation approach to resolve the symptoms. Prior to formal rehabilitation the patient was immobilized for 10 weeks. Presently, the athlete is undergoing rehabilitation focusing on pain, strength, proprioception, neuromuscular control, and function to return to sports. Typically, Steida’s process fuses to the talus one year after it appears, resulting in only few Os Trigonum factures. Additionally, Os Trigonum fractures occur in 7% of the adolescent population, manifesting around the ages of 8-13. However, this athlete is chronologically two years past the normal age range for development of this pathology. Although this athlete chronologically exceeded the normal age of Os Trigonum development, the use of growth hormones may have contributed to the delay in fusing of Steida’s process