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

Rancho Bernado Physical Therapy Clinic

Carlsbad Physical Therapy Clinic

Carmel Valley Physical Therapy Clinic

Mission Valley Physical Therapy Clinic

National City Physical Therapy Clinic

Vista Physical Therapy Clinic

by Jayson Caalaman PT, DPT

Do you work from home and spend long hours at a desk? Sitting for extended periods can result in forward or slumped posture as you maintain a repetitive reach toward your keyboard. Try these simple exercises to open up your chest and spine! No equipment is needed.

Seated Chin Tucks

Sit with an upright posture and create a double chin with your neck – sinking your head in, rather than tilting your head backward. You should feel a slight pull in the back of your head.

What is the purpose of Seated Chin Tucks?

The purpose of this exercise is to strengthen your deep neck flexor muscles which often get weakened with prolonged forward head posture.

Scapular Retraction

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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Thumb Pain: Does it Have to do With My Phone?

It comes at no surprise that Americans like their smartphones and use them daily. In 2019, the average American adult (18 years and over) spends 3 hours and 43 minutes on their phone per day (Wurmser, 2019). Use of smartphones lead to repetitive motions with scrolling of the thumb. As one may suspect, or may have experienced themselves, increased complaints of thumb pain have been reported. There is even a new term in the medical field, “texting thumb,” also known as gamer’s thumb. Houston Methodist Health (2019) describes texting thumb as occurring from repetitive use, where the inflamed tendons rub against a narrow tunnel, causing pain. 

As more people are working from home, increased complaints of tightness and soreness are brought up in the clinic. Many recognize that their computer setup at home is just not the same as at the office. Though we may not be inclined to go out and buy new chairs, desks, and computer screens immediately, there are things we can do to help reduce discomfort while working at home. 

Due to the COVID-19 pandemic, many of us are spending hours on our computers and phones. Increased time spent on your computer and phone and less time being active can increase the risk for aches and pains. To add to your exercises or walking routine, here are a few go-to stretches from head to toe that you can do daily to help maintain your flexibility, avoid repetitive strains, address your posture and improve overall well being. Should you participate in these stretches, avoid pain, be safe, and have fun!

If you have any questions or would like to schedule a time to meet with a therapist either in person or through telehealth, please contact the professionals at ProActive Physical Therapy and Sports Medicine at (760) 444-0102.

To ensure patient and staff safety and comfort, we are following all CDC guidelines which include but is not limited to: requiring masks to be worn at all times for all therapists, staff, and patients, requiring therapists to wear gloves while treating, and constant sanitization of equipment and all used surfaces. These stretches can also be found at: https://proactive4pt.com/simple-stretches-while-at-home/

Have you noticed numbness or tingling in your fingers while sleeping or after working long hours? Do you feel the need to shake your hand or rub your palm? You may be experiencing Carpal Tunnel Syndrome (CTS), the most common peripheral neuropathy in the body.

Have you ever had the thought that – “I need to start walking more, but what if I fall?” If you have, you’re not alone with this concern. Avoiding physical activity seems like a small sacrifice compared to the major risk of an injury, especially as we age. Or, you may have recently undergone surgery and are having a hard time understanding why you feel off balance and unstable when returning to activity.

I love youth sports. I love the passion and dedication that young athletes have for the game.  I love to watch teammates bond and friendships grow, forged from countless hours of practice and competition. I love to see the timid athlete find her swagger as she scores her first goal, drains her first three, or runs her PR.

All current and past patients,

We are sorry to burden you with another notice. We are pleased to say we have implemented TeleHealth/TeleMedicine into our daily business. Please understand this offering may not be for everyone as it may not fit well with your individual therapy requirements. Your ProActive therapist will help determine if TeleHealth will benefit you.

We implemented this program into our daily business to help anyone who has physical therapy or occupational therapy needs while continuing to follow the shelter-in-place requirements. For patients who want to pay cash for this service we can immediately schedule you. For patients who want to utilize insurance we will need to go through a verification process (similar to when you began therapy) to help you understand the costs.

TeleHealth is new to the physical and occupational therapy world, so we are learning as we go. We are currently up-to-date, and continue to study, which insurances accept and do not accept TeleHeath for physical and occupational therapies.

If you are interested in scheduling a TeleHealth appointment, please call 760-444-0102 and press 1 to get to our scheduling department. Please leave a message if our scheduling department does not answer (our schedulers are very busy during this crisis) and we will return your call promptly.

We continue to hope everyone is safe and healthy!

With much care,

Your ProActive Team