Talar Compression Syndrome

Abstract

Ballet dancers frequently stand on the tips of their toes in the en pointe and demi-pointe positions, resulting in compression of the posterior structures of the ankle during repeated plantar flexion of the foot, producing the talar compression syndrome. This mechanism may result in posterior block or impingement of an os trigonum or Stieda's process. When the dancer attempts to force the foot into plantar flexion, the os trigonum or the Stieda's process may be impinged between the calcaneus and the posterior edge of the tibia. Pain and tenderness are localized at the posterolateral aspect of the ankle behind the peroneal tendons. In nondancing members of the population, these conditions are usually asymptomatic. It is the requirement of the classical dance for a well-pointed foot that produces symptoms. We are reporting up to 7 years follow-up of six professional ballet dancers in whom we removed the os trigonum for symptomatic talar compression syndrome, caused by the trauma of the en pointe position of toe dancing. Two patients had bilateral operations. All six patients returned to professional dancing within a few months and remained asymptomatic. The anatomy of this condition is reviewed, as well as the diagnosis and treatment.

Endoscopic resection of a symptomatic os trigonum

“…However, if this ossification centre remains separate, it is referred to as the os trigonum [38]. When fusion does occur and there is a large intact posterolateral talar process, it is called a fused os trigonum [8], a Stieda process [5], or a trigonal process [39].…”

“…Since Rosenmuller first described the os trigonum in 1804 [5], there has been controversy concerning its origin. Stieda [41] and Turner [42] believed it to be a secondary ossification centre of the talus, whereas Shepherd [40] stated that it is an ununited fracture of the posterolateral talar process.…”

“…A symptomatic os trigonum, which is characterized mainly by posterior ankle pain, has been given many different names, including talar compression syndrome [5], posterior ankle block [21], posterior ankle impingement (PAI), and os trigonum syndrome [3,34].…”

Arthroscopic resection of symptomatic “os trigonum”

“…Since Rosenmuller first described the os trigonum in 1804 [7], there has been controversy concerning its origin. Steida [10] and Turner [11] believed it to be a secondary ossification center of the talus, whereas Shepherd [12] and Moullin [1] stated that it is an ununited fracture of the posterolateral talar process.…”

“…However, if this ossification center remains separate; it is referred to as the os trigonum [5].When fusion does occur and there is a large intact posterolateral talar process, it is referred to as a fused os trigonum [6], a Stieda process [7], or a trigonal process [8].…”