Return to Sport After Excision of Os Trigonum of Talus in Athletes.

BACKGROUND: Os trigonum syndrome is a common cause of posterior ankle pain in athletes performing repetitive hyper‑plantarflexion of the ankle. An accessory bone posterior to the talus, the os trigonum, may remain unfused or form a Stieda process, leading to pain from overuse, trauma, or impingement. Failure of conservative management often requires surgical excision. The objectives of this study are to evaluate the sustainability of long‑term pain relief and return to sport outcomes following open excision for bony impingement in athletes with os trigonum syndrome. METHODS: A retrospective chart review identified 33 athletes who underwent open posteromedial os trigonum excision after at least 3 months of failed conservative treatment for os trigonum syndrome between 2014 and 2024. Exclusions were concomitant procedures not related to os trigonum syndrome or lost to follow‑up. Demographics, return to sport status, complications, and patient‑reported pain scores were collected. Pain scores were recorded preoperatively and at <1 month, 6 weeks, 3 months, and >1 year and compared with preoperative values using paired t tests. All athletes were interviewed as their most recent follow‑up. RESULTS: The analysis included 26 athletes (35 ankles). Mean follow‑up was 7.3 ± 3.0 years. The average age was 17.4 ± 4.5 years, and 85% were female. Most were ballet dancers (n = 23), with 12% of athletes from other sports. Twenty‑five of 26 athletes returned to their sport. There was 1 reoperation for postoperative hematoma and no nerve complications. The mean preoperative pain score was 3.3 ± 3.3, with significant improvement at each time interval (P ≤ .033 for all comparisons). All athletes reported no pain at >1 year of follow-up. CONCLUSION: In this cohort of athletes with symptomatic os trigonum syndrome due to bony impingement after failed conservative management, open posteromedial excision was associated with substantial pain improvement, no neurovascular complications, and a high rate of return to sport. LEVEL OF EVIDENCE: Level IV, retrospective case series.