Virginia Research Day 2025

Medical Student Research Case Reports

15 Unusual Cause of Ankle Pain in a College Soccer Player

Delaney Yorks, OMS-II; Colleen Bannigan, DO; Greg Beato, DO; Julie Kuhlman, MAEd, LAT, ATC Corresponding author: dyorks@vcom.edu

Virginia Tech Sports Medicine Department, Blacksburg, VA

swelling and tenderness inferior and posterior to the medial malleolus, with no joint tenderness or signs of ligamentous injury. X-ray showed os trigonum, otherwise, no acute changes. MRI showed an os trigonum with marrow edema and inflammation in the syndesmotic joint which is consistent with os trigonum syndrome. Following diagnosis, the patient was referred to a specialist and underwent surgical removal of the os trigonum. Postoperatively, she was mobilized with crutches and later transitioned to a short-leg walking cast. Physical therapy was initiated with weight-bearing as tolerated. She continues to progress well. Discussion: Although our patient is a soccer player the mechanism of injury was unusual for this

syndrome. Our patient’s injury was due to a direct hit with a soccer ball to the medial aspect of the foot, rather than repetitive plantar flexion. Due to this unexpected mechanism of injury, there needed to be high clinical suspicion for other pathology given no significant improvement with general rehab. The use of MRI and close follow-up with the patient’s progress played a major role in this patient’s path to recovery. The importance of this case lies within having os trigonum syndrome on the differential diagnosis despite the unconventional mechanism of injury. Also, this case echoes the importance of timely follow-up with patients and ensuring they are improving or are being provided with the next steps needed to ensure full recovery.

Introduction: Os trigonum syndrome usually occurs due to repetitive or forced plantar flexion. The pain is a result of the trigonal process of the talus or the os trigonum being compressed between the posterior tibia and the posterior calcaneus (Major et al., 2020). The prevalence of this syndrome is higher in dancers and soccer players who routinely use plantar flexion during athletic performance (Jones et al., 1999). Case presentation: A nineteen-year-old female soccer player presented with persistent left posterior medial ankle pain after blocking a soccer ball with her medial ankle. The injury was initially treated as an ankle sprain with immobilization in a walking boot. She continued to experience pain, particularly with active plantar flexion. On examination, she had

107 2025 Research Recognition Day