Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic posterior right ankle pain, exacerbated by plantarflexion activities such as ballet, soccer, or downhill running. Reports localized tenderness behind the talus, occasional mechanical catching, and stiffness. No history of acute trauma; symptoms are insidious in onset and progressive.
Clinical Examination Findings
Inspection of the right ankle reveals no significant edema or erythema. Palpation demonstrates point tenderness at the posterolateral aspect of the talus. Forced passive plantarflexion reproduces sharp posterior ankle pain (positive impingement sign). Range of motion is limited in terminal plantarflexion. Neurovascular status is intact distally.
Treatment Protocol
Conservative management initiated: activity modification, avoidance of repetitive plantarflexion, and non-steroidal anti-inflammatory drugs (NSAIDs). Physical therapy prescribed for posterior chain stretching and strengthening. Consider ultrasound-guided corticosteroid injection into the posterior impingement area if symptoms persist. Surgical excision of the os trigonum remains an option for refractory cases.