• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.267-270
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• 2006

Os trigonum syndrome is a clinical disorder characterized by posterior ankle pain which occurs in excessive plantar flexion. The pain is elicited by the impingement of os trigonum between the calcaneus and the posterior edge of tibial plafond. Mostly, symptoms can be improved with nonsurgical management, however surgery is required for refractory cases. We report of a case of os trigonum syndrome in a female ballet dancer, which was successfully treated with subtalar arthroscopic excision of os trigonum.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.190-193
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• 2010

Both os trigonum syndrome and osteochondral lesion of talus (OLT) are common causes of ankle pain and usually affect ballet dancers or athletes. Lateral osteochondral lesions, which usually result from traumatic event, are mostly located anterolateral talar dome but rare central or posterolateral. Moreover, there are technical difficulties such as position of patient or additional posterior portal to address posterolateral lesion by arthroscopy. Meanwhile, treatment of os trigonum syndrome using arthroscopic approach has been reported in many literatures recently. However, it has not been reported to diagnose both os trigonum syndrome and posterolateral OLT together and treat arthroscopically at one stage. The authors report a case of male patient who was diagnosed as os trigonum syndrome with posterolateral OLT and treated simultaneously by hindfoot arthroscopy. Symptom was improved immediately after the operation, and radiological findings at postoperative 16 months verified remarkable healing.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.55-58
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• 2008

Purpose: The purpose of this study is to find out the clinical results of excision of the Os trigonum through a posterolateral approach and to compare the surgical results of athletes with non-athletes. Materials and Methods: Within a five year and four month period, from July 2001 to October 2006, twenty patients underwent excision of symptomatic os trigonum, with a mean age of 22 years and 9 months at the time of the operation. There were fifteen female patients and five male patients. Eight were athletes and twelve were non-athletes. Results: The average duration of postoperative follow-up was thirty months. The postoperative AOFAS scored an average of 89 points compared to the preoperative AOFAS scored an average of 67 points. Sixteen patients (80%) who were operated, had good or excellent satisfactory results. The average preoperative AOFAS score of the athletes were 61 points, compared to the average postoperative AOFAS score of 90 points. For non-athletes, the average preoperative score was 71 points, compared to the average postoperative AOFAS score of 88 points. Seven athletes (87%) and nine non-athletes (75%) had good or excellent satisfaction results after surgery. The time until full recovery averaged 88 days for all the patients. 133 days for the athletes and 56 days for the non-athletes. There is no analytic difference between result in athletes and result in non-athletes. Conclusion: Open surgical treatment through posterolateral approach of os trigonum syndrome of the ankle may be effective modality regardless of the patient being an athlete or non-athlete.

• Journal of Korean Foot and Ankle Society
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• v.15 no.4
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• pp.212-216
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• 2011

Purpose: This study was designed to analyze the usefulness of Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) in diagnosing symptomatic accessory tarsal bones. Materials and Methods: Twenty four feet (16 patients) with symptomatic accessory navicular and/or os trigonum, who agreed to take SPECT/CT, were included in this study. Fifteen feet had accessory navicular, five had os trigonum, and four had both. According to the uptake in the SPECT/CT, 11 feet were classified into high and 13 into low uptake groups. The low uptake group was treated non-operatively, while the high uptake group received operations when initial conservative management failed. A modified Kidner procedure was performed for accessory navicular and arthroscopic excision was done for os trigonum. After a mean follow-up of 6.8 (range, 3~13) months, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analogue Scale (VAS) for pain were compared. Results: Patients in the high uptake group had a higher initial mean VAS score ($7.0{\pm}0.8$ vs $2.2{\pm}0.9$, p<0.05) and a lower initial mean AOFAS score ($45.9{\pm}9.2$ vs $83.9{\pm}4.2$, p<0.05) compared to the low uptake group. All patients in the low uptake group improved after non-operative treatment. Seven patients underwent operations and had a decreased VAS ($1.6{\pm}0.5$) and an increased AOFAS score ($88.3{\pm}1.8$) at the last follow-up. Four patients in the high uptake group demonstrated erratic symptoms. Conclusion: SPECT/CT can be a useful diagnostic tool and helpful in designing treatment plans for symptomatic accessory navicular and os trigonum.

• Korean Journal of Acupuncture
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• v.39 no.3
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• pp.100-106
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• 2022

Posterior ankle impingement syndrome is one of the impingement syndromes characterized by posterior ankle pain that occurs during forced plantar flexion. This report presents a case of a 48-year-old PAIS patient with os trigonum syndrome accompanied by tenosynovitis of flexor hallucis longus. She was treated with complex Korean medicine to a good effect. The Numeric Rating Scale and the EuroQol 5-Dimension 5-Level were used to measure the impact of Korean medicine on the patient's pain and quality of life. Decreased NRS and increased EQ-5D-5L scores reflected improvement in her symptoms within 25 days. This study suggests complex Korean medicine treatment for PAIS may be beneficial for alleviating pain and improving quality of life.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.19-22
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• 2009

Purpose: This retrospective study was designed to determine the type and frequency of associated lesions in patients with chronic lateral ankle instability who had modified Brostrom lateral ankle ligament reconstruction. Materials and Methods: Between 2004 and 2007, 60 cases of 60 patients were enrolled in this study. A retrospective review of the magnetic resonance images of the affected ankle was conducted by two orthopedic surgeons who did not get any information about intraoperative findings and the lesions were admitted when two doctors were coincident. Results: The overall incidence of associated lesions found in this study was about 83%. Peroneal tenosynovitis was the highest frequency (32%), followed by osteochondral lesion of talus (28%), anterolateral impingement (15%), Os subfibula (13%), Os trigonum (12%), ankle synovitis (12%), anterior tibiofibular ligament tear (15%), anterior bony spur (7%). Another findings were loose bodies (5%), flexor tendon tenosynovitis (5%), medial osteophyte (3%). Conclusion: Identifying these associated lesions will be helpful in treating chronic lateral ankle instability especially when the surgeon have a plan to operate the instability. We suggest that the better results can be obtained when the associated lesions are corrected simultaneously.

• Journal of Korean Foot and Ankle Society
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• v.22 no.2
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• pp.49-54
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• 2018

Ankle sprains are among the most common injuries sustained during athletic activities and daily life. Acute ankle sprain is usually managed conservatively with functional rehabilitation but the failure of conservative treatment leads to the development of chronic ankle instability. The development of repetitive ankle sprains and persistent symptoms after injury has been termed chronic ankle instability. Acute ankle sprains and chronic ankle instability require a careful evaluation to detect other comorbidities, such as subtalar instability, osteochondral defect, peroneal tendinopathy, tarsal coalition, os trigonum, flexor hallucis longus tendinitis, calcaneus anterior process fracture, and neural injuries. For the successful treatment of acute ankle sprains and chronic ankle instability, the treatment of comorbidity lesions should be performed first.

• Journal of Korean Foot and Ankle Society
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• v.16 no.1
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• pp.26-30
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• 2012

The subtalar joint is a complex joint that is functionally responsible for inversion and eversion of the hindfoot. Advances in optical technology and surgical instrumentation have allowed the arthorscocpic surgeon to investiagate the small joints including the subtalar joint. Indications for subtalar arthroscopy include pain, swelling, stiffness and locking. Therapeutic indications include treatment of chondromalacia, osteophytes, arthrofibrosis, synovitis, loose bodies, osteochondral lesions, excision of a painful os trigonum, arthrodesis, and FHL tendinopathy. Contraindications to subtalar arthroscopy include infection, advanced osteoarthritis with deformity, severe edema, poor vascularity and poor skin quality. Subtalar arthroscopy is a technically demanding and difficult procedure that should only be performed by experienced surgeons. With proper instrumentation and careful operative techniques, satisfactory results may be obtained with minimal morbidity.

• Journal of Korean Foot and Ankle Society
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• v.16 no.3
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• pp.190-192
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• 2012

In the extremity surgery, pneumatic tourniquet and povidone-iodine solution are commonly used to provide an aseptic, bloodless field, and their complication rate has remained low. However, chemical burn under tourniquet has been rarely reported. Patients sustained burn injuries over the dependent, weight-bearing regions such as posterior neck, back, buttocks and posterior thighs. This rare adverse complication occurred in a 22-year-old man who underwent modified Brostrom operation with arthroscopic os trigonum excision. 10% povidone-iodine was used as topical antiseptic, and full thickness burn occurred underneath the area of tourniquet application. Main causes of povidone-iodine related chemical burn are considered maceration, irritation of the skin, long term use of the tourniquet and pressure. To reduce the complications like chemical burn, awareness of the risk and the possible pathogenesis as well as the preventive measures is important in surgical practice.

• Journal of the Korean Arthroscopy Society
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• v.13 no.3
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• pp.235-241
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• 2009

The development of good quality small-diametered arthroscopes and refined arthroscopic techniques has contributed to the improvement of the subtalar arthroscopy. The therapeutic indications are synovectomy, removal of loose bodies, debridement and drilling of osteochondritis dissecans, excision of subtalar impingement lesions and osteophytes, lysis of adhesions for post-traumatic arthrofibrosis, removal of a symptomatic os trigonum, calcaneal fracture assessment and reduction, and arthroscopic arthrodesis of the subtalar joint. The subtalar arthroscopy can be done in supine position using thigh holder or in lateral decubitus position. The arthroscope generally used is a 2.7-mm 30 degrees short arthroscope. Noninvasive distraction with a strap around the hindfoot can be helpful. Usually anterolateral, middle and posterolateral portals are utilized for inspection and instrumentation within the joint. Twoportal posterior subtalar arthroscopy in prone position can be performed as well with 4.0-mm 30 degrees arthroscope, depending on the type and location of the subtalar pathology. The subtalar arthroscopy is a technically demanding procedure, which requires proper instrumentation and careful operative technique. Possible complications are nerve damage and persistent wound drainage.