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Painful stress reaction in the posterior subtalar joint after resection of os trigonum or posterior talar process

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Abstract

Introduction

The resection of os trigonum or posterior talar process as treatment for posterior ankle impingement is an established operation. However, the authors encountered several painful stress reactions in the posterior subtalar joint during follow-up resulting in persisting incapacity to do sports.

Methods

From March 2011 to July 2015, 29 patients with 30 feet were operated (22 endoscopic, 8 open resections). Average follow-up time was 43 ± 13 months. Complications were grouped into “none”, “temporary disadvantage” and “permanent damage”. The following radiographic parameters were measured: (1) length of posterior talar process or os trigonum, (2) length of the uncovered calcaneal joint surface after resection, (3) amount of resection.

Results

The rate of permanent damage was 13.3% (4 of 30 feet), and all four of these patients developed a painful stress reaction in the posterior subtalar joint. One temporary disadvantage (persistent pain for three months) was found. All patients with major complications showed retrospectively what we call the “risk configuration” —the radius of the talus ending within the subtalar joint. The length of the uncovered calcaneal joint surface was therefore significantly larger (6.4 mm ± 3.33) in feet with permanent damage than in feet without (1.06 mm ± 2.15, P < 0.001).

Conclusion

The resection of os trigonum or posterior talar process has a complication rate of 13.3% with persisting inability to do sports due to painful stress reaction in the posterior subtalar joint. The only risk factor found was the “risk configuration”. In such cases, the resection has to be made not anterior into the subtalar joint and patients have to be informed about this possible complication.

Study design

Retrospective case series; Evidence Level 4.

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Authors and Affiliations

  1. Orthopaedic Department, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Arno Frigg & Monika Horisberger

  2. Foot and Ankle Centre Hirslanden, Witellikerstrasse 40, 8032, Zürich, Switzerland

    Arno Frigg & Gerardo Maquieira

Authors
  1. Arno Frigg
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  2. Gerardo Maquieira
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  3. Monika Horisberger
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Correspondence to Arno Frigg.

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The authors declare that they have no conflict of interest.

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There is no funding source.

Ethical approval

The study was approved by the ethical review board. This study was carried out in accordance with the Declaration of Helsinki.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

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Frigg, A., Maquieira, G. & Horisberger, M. Painful stress reaction in the posterior subtalar joint after resection of os trigonum or posterior talar process. International Orthopaedics (SICOT) 41, 1585–1592 (2017). https://doi.org/10.1007/s00264-017-3489-z

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  • DOI: https://doi.org/10.1007/s00264-017-3489-z

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