After weeks of agonizing pain in various locations in my left ankle while running (and after running) I went to a highly recommended Orthopod dr. X-rays and MRI showed a dorsal bone spur…top of my ankle where it bends. Doc said to wait until I could not stand the pain anymore before I had surgery to remove it. Or, he said that I could go ahead and have the surgery. Obviously i am on the fence about it. Recovery time is swimming after stiches come out, bike after 4-5 weeks, run after 6-8.
Anyone have any similar medical issue? If so, what did you do?
Is there an abrupt stop when you try to dorsiflex your ankle? Can you palpate the actualy spur? Any swelling after your runs? If it is halting your runs now, it won’t get any better. Dorsal exostosis off the talus or distal tibial don’t “go away” - get it removed and move on.
I have something similar called os trigonum syndrome, a buildup in my left ankle that hurts everytime I flex it, particularly swimming, when kicking puts a lot of pressure on it. In my case, the build up is behind the ankle, just above the heel. Originally, I thought it was Achilles tendonitis. For the moment, I have chosen not to have surgery, but instead am careful. Basically, I have altered my workouts to minimize the pain – limited downhill running, and swimming only with a pull buoy. It hasn’t gotten any better, but it is not any worse. Surgery is only a final option for me…
I would NOT have your os trigonum removed. That is not a true bone “spur” but a relatively common accessory ossicle behind the talus. I see them quite commonly on X-rays that most never knew they had. It rarely causes problems except in cases of extreme plantarflexion (unfortunately, this is swimming!). But, it is a surgery fraught with complications.
Rodney, I understand os trigonum is seen quite frequently in soccer players and ballet dancers. I think I developed mine by doing a lot of open water swims with consistent plantarflexion and no “relief” associated with flip turns where you have a chance to flex the other way (dorsalflexion?). Anyway, I have been reading that often this problem goes away with corticosteroid injections, which I have not done yet. Any thoughts?
The actual accessory ossicle (the little jelley bean sized bone you can see at the posterior aspect of the ankle joint) doesn’t ever go away. Its just that the location of the small ossicle tends to irritate the posterior ankle joint capsule, or flexor hallux longus tendon as it runs back there with extreme plantarflexion. The corticosteroid injection would simply be to decrease any inflammation in the area from the small accessory bone, nothing else.
I don’t seem to have much inflammation, but it hurts nonetheless. Basically, I can only kick very lightly with my left leg. It has hurt my swimming a fair bit and will probably add a few (maybe 5) minutes to my IM time. It’s actually a little embarrassing because 20 years ago, I swam in the US Olympic Trials. Now, I kind of look like a triathlete who took up swimming a few years ago.
I tried to rest it for a few weeks, but it did not go away. Any other thoughts about how to alleviate or eliminate the pain?
No… movement of the big toe seems not to have any impact. But simply plantarflexing the foot hurts independent of whatever the big toe is doing.
Contralateral? Is that the other ankle? There is definitely no pain there. I don’t know if I have any ossicle behind the talus. I would have to look at the x ray again. I am not surprised that it’s in one ankle and not the other since I have an unbalanced stroke that relies heavily on the left leg kick (as a result of an old 4 beat kick that no one would ever try to teach today).
I also have a large os trigonum on my right ankle that has been causing me pain when swimming and at times biking and running. I had a cortisone shot about 7 or 8 months ago now that helped a lot but the pain is starting to come back. It isn’t nearly as bad as before, but I definitely cannot fully plantar-flex my ankle without pain. I’d like to “cure” this problem by having the surgery but I noticed you said that there are numerous possible complications associated with the surgery. From what I have read, the surgery is largely successful and isn’t all that risky. Is this a surgery that you would not recommend unless I am completely unable to train at any level? Also, I often have tightness in my soleus on the effected leg that can cause considerable soreness if I am running often. Could the os trigonum be affecting my flexibility in my calf muscles and causing this pain.
The problem with an os trigonum is that they are very common, yet rarely an issue. Now, fully pointing toes in ballet or swimming would be one for sure. No, it shouldn’t be limiting gastroc/soleus motion or “cause” tightness - that is just from being a runner/cyclist in general.
The surgery itself is a little difficult because of some important neurovascular issues in the area. But the main problem is that removal of the os trigonum may fail to give relief since it wasn’t the cause of your original symptoms.
So, the question is always when to operate. If you are certain it is from the os trigonum/impingement and it interferes with your lifestyle (i.e. a swimmer, dancer, etc.), sure, remove it. You don’t have to wait until it hurts on every step.