The os trigonum and os peroneum are accessory ossicles (extra bones) in the ankle/foot that are present at birth (congenital) in some people.  Most of the time, these extra bones go unnoticed.  They may be identified on x-rays, but are often asymptomatic and do not need to be addressed.  However, as a result of overuse or an injury, these bones and the surrounding tissue and/or joints may become inflamed and painful.  The terms Os Trigonum Syndrome and Os Peroneum Syndrome are used to describe the painful symptoms.

The os trigonum can form behind the ankle bone (talus) during adolescence when it does not fuse with the rest of the ankle bone leaving a small extra bone.  This bone can get pinched between the talus and calcaneus (heel bone) with repeated downward pointing of the foot/toes during sports activity (eg – soccer).  Ballet dancers can develop a “nutcracker injury” due to spending frequent and prolonged time on their toes which can crunch the os trigonum causing inflammation in the area. 

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The os peroneum is an accessory bone that is located in the peroneus longus tendon which passes over the lateral aspect of the foot.  About 1 in 5 people have this extra bone.  This bone and the surrounding tendon can become inflamed with repetitive activity such as running and jumping or with an acute injury like an ankle sprain. 

Signs and symptoms of both these syndromes include:  swelling in the back of the ankle (os trigonum) or lateral foot (os peroneum), tenderness in the area, pain with pushing off the foot/toes when walking, and weakness.  X-rays or other imaging can confirm the presence of these accessory bones. 

Conservative treatment of these syndromes involve the following:

•             Rest – avoiding aggravating activities such as running, jumping, dancing, etc.

•             Immobilization – a walking boot may be prescribed to limited motion of the ankle/foot

•             NSAIDs and cold packs – to reduce pain and inflammation

•             Physical Therapy – to restore normal flexibility/mobility, increase strength/stability and assist with return to ADLs and recreation/sports

If symptoms persist, then steroid injections may be used.  Surgical intervention may be required to remove the os trigonum or os peroneum.  Following surgery, physical therapy can be prescribed to regain ROM, strength, balance/stability, endurance, and to facilitate return to prior level of function.

If you have questions or would like to learn more about this topic, contact the therapy professionals at ProActive Physical Therapy and Sports Medicine for help.

For Accessory Navicular Syndrome Exercises, Visit One of Our San Diego Area Clinics

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Recently, my 13 year old son, who plays a lot of basketball, complained about having pain along the arches of his feet. Initially, I suspected it was probably “growing pains”.  At this age, many kids start to have pain symptoms in their knees (Osgood-Schlatter disease) or heel area (Sever’s disease).  Upon further inspection, we determined that he may have a condition called “accessory navicular syndrome” (ANS).

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When I first began my career in physical therapy (PT), I wanted the opportunity to be able to make a significant difference in someone’s life.  I envisioned myself working in an outpatient clinic and helping patients get back to doing something they loved. Maybe it was the runner with the sprained ankle or the baseball pitcher with a torn rotator cuff.  

The epiphyseal plate aka “growth plate” is the area of new bone growth near the ends of the long bones in children/adolescents.  Long bones include: the femur (thigh), the tibia and fibula (shin), the radius and ulna (forearm), and the bones of the hands and feet.  There is typically one growth plate at each end of a long bone. As your child ages and grows, the growth plates harden and become solid bone.  Once this process is complete, the growth plate is closed and no additional growth occurs. Growth plates usually close near the end of puberty (13-15 years for girls and 15-17 years for boys) [1].  

Hip pain is very common and can have several causes such as tendonitis, bursitis, and arthritis. The location of the pain symptoms can often provide a better understanding of the underlying cause. For example, lateral hip pain is often due to bursitis and IT Band Syndrome. Typically, problems in the groin area are related to structures inside the hip joint.

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The hip joint is a ball and socket joint where the top of the thigh bone (femur) and pelvis meet. This joint is typically very stable, but can still get injured especially at the labrum. The labrum is a cuff of cartilage that forms a ring around the edge of the hip socket (acetabulum). This cartilage tissue lacks good blood supply, therefore, does not heal well following injury. Labral tears can be a result of a sudden trauma (eg – car accident or a fall), repetitive movements during exercise or athletics, or can be degenerative over a period of time due to FAI or OA. Continue Reading »

The medial patellofemoral ligament (MPFL) is one of the many ligaments in and around the knee joint. As its name suggests, the ligament runs from the patella (kneecap) to the femur (thigh bone). It plays a very important role in stabilizing the patella during knee movement. Injury to the MPFL often occurs during non-contact twisting motions (eg – a sudden change of direction, pivoting) which can cause the patella to dislocate laterally. Symptoms following a patellar dislocation include pain, swelling, stiffness, and weakness in the knee. Treatment typically follows the PRICE protocol of protection, rest, ice, compression, and elevation. NSAIDs can also help decrease symptoms.

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Are you experiencing numbness, tingling, or burning pain in your outer thigh?  We often suspect that these types of symptoms are related to our lower back (eg – sciatica).  However, there is a condition called “meralgia paresthetica” (MP) that could be the actual cause of the symptoms.  With sciatica, the sciatic nerve becomes irritated and pain can be felt from the lower back and down the back of the thigh and leg. With MP, the lateral femoral cutaneous nerve becomes compressed or pinched.  This results in tingling, numbness and/or burning on the lateral (outer) aspect of the thigh.

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As spring approaches, so does the start of baseball season.  This means a lot of throwing activities and also means many young players (ages 8-15) developing elbow pain.  “Little Leaguer’s Elbow” aka medial epicondyle apophysitis is a common overuse injury associated with overhead throwing.  It should be noted that other young athletes who play volleyball, tennis, and football (quarterback) can also develop this condition.  Little Leaguer’s elbow is the result of repetitive stress/strain to the growth plate on the inner part of the elbow known as the medial epicondyle.  With frequent overhead throwing, the growth plate can become very irritated and inflamed.  Symptoms typically include pain (achy, sharp), tenderness, swelling, and stiffness along the inside of the elbow.  Pain is usually worse when trying to throw the ball hard or far.  Early detection is important and you should consult a doctor right away when symptoms occur.

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In 2015, there are 688 marathons scheduled in the United States. First-time participants as well as experienced runners will follow a fairly strict training routine in order to prepare for the big event. As race day approaches, runners will pay particular attention to their mileage, what they eat, and how much rest they get. But what about after the race? Many first time participants fail to have a post-marathon plan which may lead to delayed recovery, unnecessary injury, or decreased health. Here are some tips to make your recovery a successful one:

Immediately after the race:

• keep walking for about 10-15 minutes to allow your heart rate to gradually drop
• drink several cups of water or a sports drink to begin to rehydrate
• change into dry clothes/shoes or use a Mylar blanket to stay warm
• do some gentle stretching
• eat a small snack of simple carbohydrates (eg – fruit, energy gels/bars, bagels)

Back at your room or home:

• soak in cold bath (55-65 degrees) for 10-15 minutes
• elevate your legs to help with circulation
• wait 2-6 hours before using foam roller and 24 hours before getting a massage
• continue to rehydrate with water and/or sports drink
• eat a meal similar to your pre-race meal that includes lots of carbs and some protein
• walk again to keep your muscles loose and promote circulation/healing

The first week after the race and beyond:

• take at least a week off from running and then gradually ease back to it
• treat any injuries you may have sustained (eg -blisters, strained muscle)
• get lots of sleep
• continue walking and gentle stretching
• stay on a well-balanced diet
• nourish your immune system since it can get depressed from the race

By having a post-marathon plan in place, you can make the experience of completing a marathon a more enjoyable one!