Tales of an Os Trigonum (Or, Why Does My Right Foot Suck?)

If you’ve read my first post and are wondering, “What the #$%^ is an os trigonum? I’ve never heard of that,” you’re not alone. I had no idea I had an extra bone hanging out in my ankle — or that it had a name — for a year and a half after it started causing problems. One of my friends asked, “An extra bone? How is that even possible?”

Here’s a quick briefing from my non-medical-expert perspective: Around 5-10% of people have an os trigonum, a small accessory bone in the back of the ankle. Most of them will never know it’s there or experience any issues because of it. The lucky few who do include ballet dancers and soccer players — athletes who repeatedly point their toes downward (and, in a dancer’s case, put weight on their foot in this position).

This is sometimes called a “nutcracker injury” because the os trigonum is crunched like a nut in a nutcracker between the ankle and heel bones, and the tissues around it become irritated and painful. Can any other dancers appreciate the irony?

(Source: foothealthfacts.org)

For me, the fun started back in the summer of 2010. I was barefoot and doing releves in the bathroom (naturally) when I noticed that my right heel wasn’t as high off the ground as my left. I didn’t feel any pain, but thought it was strange that my range of motion seemed to have changed for no reason.

That fall, when Nutcracker rehearsals started and my time on pointe increased, I began feeling a tendonitis-like pain on the inside and deep in the back of my ankle. By the time Nutcracker was over, my ankle was so stiff and sore that I could barely point and flex my foot. (How did I get through a full-length ballet like that, you ask? Stage magic, my friends. And gobs of extra-strength Tiger Balm.)

In short, over the next year and a half, this cycle continued. I saw an orthopedics/sports medicine doctor, who diagnosed posterior tibial and Achilles tendonitis, and tried the following treatments: rest (at least a month off ballet, several times), physical therapy, ice, heat, walking boot, Graston technique, two prescription anti-inflammatories, and a partridge in a pear tree.

Left foot: Not a crazy banana foot, but it'll do.

Right foot: See how high the ball of my foot is, compared to the left? For a dancer, this can make the difference between being on pointe and...not.

By this spring, I had grown frustrated at the way I continued to grow stronger in ballet and improve my technique, but only on one side. I felt confident holding long balances on pointe, doing double pirouettes and fouettes, etc. on the left, but struggled just to get to full pointe on the right. At home, I was also working with a Theraband to stretch and strengthen my feet, and my right just seemed to get “stuck” while my left kept improving. While pretty much every dancer has a better side, the difference in range of motion and stability was so pronounced that I started to realize that something more significant than tendonitis might be going on.

To be continued! (Not to be dramatic, really. Just because this post is getting a little long for a world with a 140-character attention span.)