Q: I am a 22 years old male whose right ankle got injured while playing football two years back. I rested for two months. But it still pains when I twist my right ankle and subsides within a couple of minutes. I can do normal daily activities without any pain. But I cannot play any physical games. I haven't met the doctor yet. Do I need surgery? My MRI report showed normal alignment of all the bones, an enlarged fat marrow containing Os Trigonum is seen with degenerative signal change between Os Trigonum and talus. Marrow oedema is noted within Os Trigonum with synovitis in posterior synovial recess of tibio-talar joint. A thickened posterior inter malleolar ligament is noted. Fluid signal is noted around intact flexor hallucis longus tendon. Sclerosis is noted involving articular ends of talus and navicular with degenerative cystic change in talar articular surface of the joint. There is no significant free fluid in the ankle joint. All the major ligaments are normal in signal intensity. There is no destruction / discontinuity in any of the major ligaments. Tendon achilles is normal. Impression - posterior ankle impingement syndrome (Os trigonum syndrome) with synovitis of FHL tendon sheath and degenerative change involving talo-navicular joint. Please suggest.

A:In Os Trigonum syndrome relief is often achieved through conservative treatments like - rest, immobilization, ice packs (do not put ice directly against the skin), oral medication- NSAIDs such as ibuprofen, diclofenac may be helpful in reducing the pain and inflammation. 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 involves removal of the extra bone as it is not necessary for normal foot function.