What is Os Trigonum Syndrome?

The os trigonum is an extra (accessory) bone that sometimes develops behind the ankle bone (talus). It is connected to the talus by a fibrous band. The presence of an os trigonum in one or both feet is congenital (present at birth). It becomes evident during adolescence when one area of the talus does not fuse with the rest of the bone, creating a small extra bone. Only a small number of people have this extra bone.
Often, people don't know they have an os trigonum if it hasn't caused any problems. However, some people with this extra bone develop a painful condition known as os trigonum syndrome.

Os trigonum syndrome is usually triggered by an injury, such as an ankle sprain. The syndrome is also frequently caused by repeated downward pointing of the toes, which is common among ballet dancers, soccer players, and other athletes.
For the person who has an os trigonum, pointing the toes downward can result in a "nutcracker injury". Like an almond in a nutcracker, the os trigonum is crunched between the ankle and heel bones. As the os trigonum pulls loose, the tissue connecting it to the talus is stretched or torn and the area becomes inflamed.
The signs and symptoms of os trigonum syndrome may include:

• Deep, aching pain in the back of the ankle, occurring mostly when pushing off on the big toe (as in walking) or when pointing the toes downward
• Tenderness in the area when touched
• Swelling in the back of the ankle

Os trigonum syndrome can mimic other conditions such as Achilles tendon injury, ankle sprain, or talus fracture. Diagnosis of os trigonum syndrome begins with questions from the doctor about the development of the symptoms. After the foot and ankle are examined, x-rays or other imaging tests are often ordered to assist in making the diagnosis.
Relief of symptoms is often achieved through treatments that can include a combination of the following:

• Rest. It is important to stay off the injured foot to let the inflammation subside.
• Immobilization. Often a walking boot is used to restrict ankle motion and allow the injured tissue to heal.
• Ice. Swelling is decreased by applying a bag of ice covered with a thin towel to the affected area. Do not put ice directly against the skin. 
• Oral medication. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
• Injections. Sometimes cortisone is injected into the area to reduce the inflammation and pain. 

Most patients' symptoms improve with non-surgical treatment. However, in some patients, surgery may be required to relieve the symptoms. Surgery typically involves removal of the os trigonum, as this extra bone is not necessary for normal foot function.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow our tweets on Twitter. 

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Do I Have A High-Arched Foot?

Cavus foot, or high-arched foot, is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age, and can occur in one or both feet.
Cavus foot is often caused by a neurologic disorder or other medical condition such as cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy, or stroke. In other cases of cavus foot, the high arch may represent an inherited structural abnormality.

An accurate diagnosis is important because the underlying cause of cavus foot largely determines its future course. If the high arch is due to a neurologic disorder or other medical condition it is likely to progressively worsen. On the other hand, cases of cavus foot that do not result from neurologic disorders usually do not change in appearance.
The arch of a cavus foot will appear high even when standing. In addition, one or more of the following symptoms may be present:

• Hammertoes (bent toes) or claw toes (toes clenched like a fist).
• Calluses on the ball, side, or heel of the foot.
• Pain when standing or walking.
• An unstable foot due to the heel tilting inward, which can lead to ankle sprains.

Some people with cavus foot may also experience foot drop, a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step. Foot drop is usually a sign of an underlying neurologic condition.
Diagnosis of cavus foot includes a review of the patient's family history. The foot and ankle surgeon examines the foot, looking for a high arch and possible calluses, hammertoes, and claw toes. The foot is tested for muscle strength, and the patient's walking pattern and coordination are observed. If a neurologic condition appears to be present, the entire limb may be examined. The surgeon may also study the patterns of wear on the patient's shoes.
X-rays are sometimes ordered to further assess the condition. In addition, the surgeon may refer the patient to a neurologist for a complete neurologic evaluation.
Non-surgical treatment of cavus foot may include one or more of the following options:

• Orthotic devices. Custom orthotic devices that fit into the shoe can be beneficial because they provide stability and cushioning to the foot.
• Shoe modifications. High topped shoes support the ankle, and shoes with heels a little wider on the bottom add stability.
• Bracing. The surgeon may recommend a brace to help keep the foot and ankle stable. Bracing is also useful in managing foot drop. 

If non-surgical treatment fails to adequately relieve pain and improve stability, surgery may be needed to decrease pain, increase stability, and compensate for weakness in the foot.
The surgeon will choose the best surgical procedure or combination of procedures based on the patient's individual case. In some cases where an underlying neurologic problem exists, surgery may be needed again in the future due to the progression of the disorder.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow our tweets on Twitter. 

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What's That Bump on My Big Toe?

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes, sometimes overlapping a third toe (known as Hallux Valgus). The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Valgus. Bunions can also lead to other toe deformities, such as hammertoe. 

Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and

friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult- all contributing to chronic pain. Wearing shoes that are too tight is the leading cause of bunions. Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries. 

Treatment for Bunions

Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain caused by irritations, and second, to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:

• The use of protective padding, often made from felt material, to eliminate the friction against
  
  shoes and help alleviate inflammation and skin problems. 
• Removal of corns and calluses on the foot.
• Changing to carefully-fitted footwear designed to accommodate the bunion and not contribute toward its growth. 
• Orthotic devices- both over-the-counter and custom made- to help stabilize the joint and place the foot in the correct position for walking and standing. 
• Exercises to maintain joint mobility and prevent stiffness or arthritis. 
• Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable. 

Surgical Treatment

Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe. 

Ayman M. Latif, DPM

Connecticut Foot Care Centers

Foot Deformity Doctor in Glastonbury, CT

Podiatrist in CT

Visit our website, like our page on Facebook, and follow our tweets on Twitter. 

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