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Gouty os trigonum tarsi: case report.

P L Lai1, W E Yang, W J Chen

  • 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.

Changgeng Yi Xue Za Zhi
|March 13, 1999
PubMed
Summary

Os trigonum syndrome, common in athletes, typically results from ankle impingement. This case highlights posterior heel pain caused by tophaceous gout around the os trigonum, a rare presentation.

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Area of Science:

  • Orthopedics
  • Rheumatology
  • Podiatry

Background:

  • Os trigonum tarsi is an anatomical variant present in 7% of adults, often asymptomatic and incidentally discovered.
  • It is frequently observed in athletes involved in activities requiring repetitive ankle plantarflexion, such as ballet dancers, javelin throwers, and soccer players.
  • The typical pathogenesis of os trigonum syndrome involves impingement of the ossicle or a fractured posterior talar tubercle against the tibial plafond.

Observation:

  • A case study of a young man presenting with posterior heel pain is detailed.
  • The patient's pain was attributed to tophaceous gout accumulating around the os trigonum tarsi.
  • This presentation diverged from the usual etiology of hyperflexion-induced impingement.

Findings:

  • Histopathological examination revealed a significant giant cell reaction and pseudotumor formation associated with the tophaceous deposits.
  • The study reviews the clinical characteristics of both os trigonum tarsi and gout.
  • The patient's specific treatment approach for this unusual presentation is discussed.

Implications:

  • This case expands the differential diagnosis for posterior heel pain in individuals with os trigonum tarsi.
  • It underscores the importance of considering systemic inflammatory conditions like gout in the etiology of symptomatic os trigonum.
  • The findings suggest that atypical presentations of os trigonum syndrome may require a multidisciplinary approach involving orthopedic and rheumatologic evaluation.

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