Back of the Ankle Pain due to Os Trigonum
An os trigonum is an accessory bone that some people have located on the posterolateral surface of the talus, or top of the heel bone. Many times, there are no symptoms related to this accessory bone so people will not know they have one. But the os trigonum can become symptomatic with excessive pointing, or plantarflexion, of the foot as in ballet en pointe.
(healingfeet.com) (foothealthfacts.org)
Heel pain can be made worse by tightness of the muscles along the back of the foot, weakness of the muscles around the ankle, tightness of the ankle joint, improper technique, and improper fitting shoes.
Stretch the following muscles along the back of the foot:
1) Flexor Hallucis Longus muscle, or Great Toe muscle
2) Gastrocnemius muscle (Figure 1)
3) Soleus muscle (Figure 2)
Figure 1, Gastrocnemius Stretch:
(walkaboutmag.com)
Figure 2, Soleus Stretch:
(walkaboutmag.com)
Strengthen the following muscles surrounding the ankle:
1) Gastrocnemius
2) Soleus
3) Flexor Hallucis Longus
4) Peroneals
5) Posterior Tibialis
6) Anterior Tibialis
Review your technique for releve, tendu and jumping to ensure you are in proper ankle, knee and hip alignment.
Frequently change your shoes and avoid dancing in improper fitting or “dead” shoes.
Use ice after class to decrease pain and inflammation.
If your pain does not improve, you should be examined by a healthcare professional. Joint mobilizations can give you more ankle motion, manual therapy may release any soft tissue restrictions, and exercises given by a physical therapist (PT) can get you back to dance. It is important to find a Dance Medicine PT who understands you and your art.
A physician can evaluate to see if an os trigonum is your problem and if surgery is recommended.
Agile Physical Therapy can perform technique analysis and physical therapy to dancers who may be having this problem.
Jamie Doyle, PT, DPT
Agile Physical Therapy
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