Geovany Soto and His Os Trigonum

Geovany Soto and His Os Trigonum His Os Trigonum is gone thank goodness! He should be ready to rock and roll by opening day! What is this Os Trigonum latin-sounding thing anyway?? An Os Trigonum is a small extra bone that is connected to the back of one of the bones that make up the ankle. If we have one, it has been there since birth. This bone is meant to fuse to the back to this ankle bone (known as the talus) as we grow, but sometimes it does not and ends up sitting back there, usually well behaved. When a catcher with an Os Trigonum (like Geovany Soto) squats, this bone can get pinched and cause a great deal of pain and swelling in the back of the ankle! The pain can act like Achilles tendonitis and is commonly mistaken for this. When ice, rest and anti-inflammatories don’t help, the options are to put the foot in a big black surgical boot for a while (not an option when the Rangers need him ASAP!) or to take the bone out! The surgery itself involves an incision between the outside of the Achilles and the ankle bone. The bone is carefully shelled out and the skin is sewn up!

That is it pretty much! Recovery is much quicker that an Achilles tendon surgery and the relief is outstanding! He is no worse for the wear without this extra bone and the Rangers are all the better because of it (one can only hope)!

Why Do Some Younger People Get Arthritis in their Ankles?

Younger patients can experience arthritis in their ankles. There is no age limit, young or old, for this painful disorder. Some people have arthritis caused by a systemic disorder like juvenile rheumatoid arthritis. Most have a more traumatic type of arthritis caused by an injury.

In the majority of younger patients with ankle arthritis, their arthritis is usually a secondary effect from too many ankle sprains. Most can relate a twisting type of injury which caused a deep cartilage injury that is often called osteochondritis dissicans. This has been seen to occur with no obvious trauma, but most can relate a history of severe sprain. Over time, the injured cartilage starts to deteriorate, then flake and finally many patients have bone on bone contact which is extremely painful.

Osteochondritis often causes significant pain, swelling and stiffness in the ankle. Patients come in several months after experiencing a bad sprain complaining of continued popping, instability, stiffness and pain. Some complain of severe discomfort, but most relate a chronic annoying ache.

Ankle sprains should not be ignored, because many lead to chronic instability and eventual arthritis. A physical examination by your podiatrist is usually followed by x-rays. If plain film x-rays are negative, and you have had pain for more than 2 months from an ankle sprain; an MRI is indicated to rule out a cartilage injury of the talar dome. This MRI can evaluate the cartilage of the talar dome for obvious flaps and for subchondral injury to the underlying bone. A chip fracture can be quite painful and feel like a clicking every time you move your ankle.

Conservative therapy for osteochondritis includes bracing, physical therapy, anti-inflammatories and rest. Many people do well with just conservative therapy and maintain their joints by working on their proprioception and strength.

Unfortunately, surgical intervention of ankle arthriscopy is often needed to remove the cartilage fragments and place tiny drill holes in the deficit to encourage the formation of fibrocartilage or scar tissue. Severe defects may require cartilage grafting.

So, for all you young sports stars out there: Remember that ignoring multiple ankle sprains and ankle instability is usually a prescription for long term arthritis. Osteochondiritis leads to good old fashion osteoarthritis. Arthritis pain can be treated with anti-inflammatories, bracing, and in severe cases; an ankle fusion of joint replacement. In the end, most people wish they had consulted their doctor for their ankle sprains early on and avoided long term arthritic pain.

Albert Pujols Twists His Ankle

“Ouch!” Did you see the replay of Albert Pujols twisting his ankle sliding into base? It actually looked much worse than it was in the instant replay. Looked terrible, but he toughed it out and stayed in the game. Boy, did it look like he was going to be in pain this morning! Over and over they played the tape on Sports Center!

What should you do if this happens to you or your child athlete? The trainer from the Cardinals was immediately evaluating Pujols, but most of us don’t have a trainer on standby!

If you have an ankle sprain, you should be evaluated by a sports medicine podiatric foot and ankle surgeon if you have localized pain, swelling and bruising, as well as inability to walk more than 5-7 steps comfortably. Many a foot fracture has been missed in the emergency room when x-rays were taken only of the ankle and not the foot. The fifth metatarsal is often broken with the same mechanism of injury of an ankle sprain, so the foot should be evaluated as well. If severe ligament injury is suspected, an MRI can evaluate the grade of injury. This is really what decides whether surgery is needed for full recovery.

Treatment for ankle sprains really depends on the degree of severity, which can only be determined by your doctor. Initial treatment always includes “R-I-C-E” therapy – Rest, Ice, Compression, and Elevation. Pain and edema is usually controlled with NSAID’s (non-steroidal anti-inflammatories) like ibuprofen. Bracing or casting coupled with non-weightbearing on crutches may be needed in more severe injuries to rest and stabilize the ankle while it heals. Return to pain-free ROM(What is ROM?) and stability is the goal. Surgery is only recommended in Grade 3 severe injuries in athletes or in those patients who have had multiple ankle sprains and suffer from chronic ankle instability. Long-term ankle instability can often be avoided with an aggressive physical therapy program. Bracing should only be used in the short-term during rehabilitation because long-term bracing actually causes atrophy and decreased ROM.

Physical therapy is needed for all ankle sprains. The goals of physical therapy should be to regain full ROM, strength and proprioception (where your brain thinks your ankle is in space). Regaining strength in the peroneal tendons as well as overall balance training are the keys to successful rehabilitation of an ankle sprain. A maintenance program of ankle strengthening, stretching, and proprioception exercises helps to decrease the risk of future ankle sprains, particularly in individuals with a history of multiple ankle sprains or of chronic instability.

Bottom line: if you happen to fall down and go “Boom”, have your ankle sprain evaluated by a podiatric foot and ankle surgeon. Delaying treatment and rehabilitation can lead to life-long instability.

For more information on ankle sprains and chronic instability, click here.