Foot & ankle · Posterior impingement

Accessory trigonum resection in Canada

Accessory trigonum resection treats posterior ankle impingement from a symptomatic os trigonum — an extra bone behind the ankle — using minimally invasive arthroscopy, with attention to the adjacent FHL tendon. It’s common in dancers and athletes who plantarflex repetitively. Consultations with our fellowship-trained foot and ankle surgeons in 1–3 days, with surgery typically 2–4 weeks later. Most patients are discharged the same day, with protected weight-bearing for the first 1–2 weeks and return to sport-specific training around 8–12 weeks.

At Pathway, our fellowship-trained foot and ankle surgeons perform accessory trigonum resection. Consultations are available in 1–3 days, with surgery typically 2–4 weeks later.

Book a consultation (647) 799-3230
  • Most patients discharged same day
  • Two 5mm posterior portals
  • Surgery in 2–4 weeks
  • No referral required
Active patient moving on a pickleball court after ankle recovery
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Minimally invasive arthroscopy

At a glance

Accessory trigonum resection at a glance

Accessory trigonum resection treats posterior ankle impingement from a symptomatic os trigonum — an extra bone behind the ankle — using minimally invasive arthroscopy, with attention to the adjacent FHL tendon.

1–3 days
to first consultation
2–4 weeks
from consult to surgery
Same day
most patients discharged
8–12 weeks
typical return to sport training
The condition

Understanding posterior impingement.

Posterior ankle impingement syndrome is a clinical condition characterized by pain at the back of the ankle, specifically during activities that involve maximal plantarflexion (pointing the toes). This “nutcracker” effect occurs when the os trigonum — an extra bone present in about 15–25% of people — is compressed between the talus and the calcaneus (heel bone).

While often asymptomatic, this extra bone can lead to chronic inflammation and sharp pain in dancers, athletes, and individuals who have suffered an ankle sprain. Surgical resection becomes necessary when conservative measures like rest, injections, and physical therapy fail.

Common indications

Advanced technology

Arthroscopic visualization & precision.

Our surgeons utilize the latest arthroscopic tools designed for targeted resection and minimal downtime.

Arthroscopic approach

Performed through two 5mm incisions at the back of the ankle (posterior portals). This approach is intended to provide excellent visualization of the impingement site while avoiding large incisions and extensive tissue dissection.

Precision instrumentation

High-speed burrs and specialized shavers designed for efficient bone removal. These tools allow for precise contouring of the talus, aimed at preventing future impingement while protecting the surrounding tendons and nerves.

Your surgeon

Our posterior ankle specialist.

Fellowship-trained surgeon expert in posterior ankle arthroscopy and sports medicine.

Dr. Danny Arora, posterior ankle arthroscopy surgeon

Dr. Danny Arora

Minimally invasive foot & ankle surgery · Duke University fellowship trained

Dr. Arora is Duke University fellowship trained in minimally invasive foot & ankle surgery, with expertise in posterior ankle arthroscopy for impingement in dancers and athletes.

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FAQ

Frequently asked questions.

An os trigonum is an extra (accessory) bone that sometimes develops behind the ankle bone (talus). It is present in a small percentage of the population and can become symptomatic when it gets pinched between the ankle and heel bones during certain movements.

Posterior ankle impingement syndrome occurs when the os trigonum or surrounding soft tissues are compressed at the back of the ankle during plantarflexion (pointing the toes). This is common in ballet dancers, soccer players, and athletes.

Our surgeons often utilize a minimally invasive arthroscopic approach through two small incisions at the back of the ankle. Using advanced visualization and specialized instruments, the extra bone is precisely removed with minimal tissue disruption.

Recovery from the arthroscopic approach is typically faster than open surgery. Most patients use crutches or a boot for 1-2 weeks, then transition to normal footwear. Full return to high-impact activities usually occurs within 8-12 weeks.

Athletes and dancers can often begin sports-specific rehabilitation at 6 weeks post-op, with a gradual return to full performance by 3 months, depending on individual healing and strength.

No referral is required. You can book a consultation directly with our foot and ankle team to discuss your posterior ankle pain and imaging results.

Next step

Start your care journey.

Schedule a consultation to discuss your posterior ankle pain and explore whether accessory trigonum resection is right for you. No referral required.

Book a consultation (647) 799-3230
Related links

Continue your research.

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