Question
Dr. March Katz,

Hello, I am the athlete to which my coach has talked to you about. When I was at home, I got an x-ray taken which showed the little bone, that sticks off the end of the heal, broken off. There is a distinct break which occured. The doctor I saw couldn't tell me exactly when the break occured, but the fact that I had been playing with the broken bone was a concern of his. This is all off an x-ray, I have not had an MRI taken.
  Before the x-ray, the "test" the doctor gave me, to see where exactly my foot was hurting, consisted of numerious motions of moving my foot (up, side-to-side, circles, etc). The motion that hurts the most is when my feet are originally pointed to the sky, and then are pushed down towards the ground. After I told the doctor how much that hurt, he then preceded to take an x-ray.
  As for pain concerning my big toe, I have not noticed any unusual pain. However, sometimes it is painful to walk because the bottom of my heal hurts when I put pressure on it. As I said, this does not happen all the time, but occasionally.
 I haven't noticed any swelling around my foot.

 After knowing the additional information I provided about my foot, do you think "taking it easy" could heal the broken bone? Also, do broken bones, like mine, usually heal on their own? Any advice as to what I should do, or how the healing process occurs would be helpful! I am a huge fan of playing sports and running and can't wait to get back at it! I would like to get this foot problem taken care of in the shortest time possible!

Thanks a lot for the response you have already given. I am eager to hear your thoughts and any additional advice you have to offer!

- problemed athlete  
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The text above is a follow-up to ...

-----Question-----
I'm a tennis coach and one of my athletes has been diagnosed with a
"floating" piece of bone just off the talus, I believe.  It is called an os
trigonum.  I've researched it for information regarding diagnosis and
treatment; but information regarding how it could heal with immobilization is
no where to be found. The treatment prescribed is okay, as far as I can tell,
("take it easy" and wrap appropriately when exercising) but I'd like to provide
some information regarding how this healing can take place so that she can
visualize it happening and have a positive attitude (hope) that it can happen.  
We want to avoid surgery, if possible.  Thanks for any help you can provide.
-----Answer-----
Barbara,

What types of tests have been done?  Is there pain with up and down movement of large toe?  Is there swelling of the area?

Has imaging shown an actual fracture or just irritation.  Has there been an MRI?

Immobilization helps because there are tendons that cross the area where the Os Trigonum is attached to the talus.  These tendons, especially the tendon that eventually leads to the large toe (flexor hallucis longus tendon), when moving continue to irritate the inflammed or floating bone.  Decreasing the motion keeps these soft tissues from hitting the injured bone.

Also, any movement of the talus joint or subtalar joint will cause irritation.

Immobilization will decrease motion which is harmful.

If you can find a picture anatomy book you can see the relationship between the Os trigonum and the tendon.

Try this: http://education.yahoo.com/reference/gray/subjects/subject;_ylt=Akp7q8dxU7bTG1Tx

Hope that helps.

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
http://www.theTampaPodiatrist.com
http://www.tampacryosurgery.com  

Answer
Hi Barbara,

I'm still not convined that you have an Os Trigonum fracture.  Often on x-ray, you will see what appears to be a fracture but is actually this extra bone with cartiage attaching to the talus bone. This may be a normal appearance.

I would get an MRI to be sure nothing has been missed.  You may also have plantar fasciitis which causes heel pain. You can see the condition on my website.

You may benefit from orthotic devices, custom arch supports.

If you have a fracture or any condition that may cause soft tissue swelling, rest is important.

You may want to seek a second opinion and get the MRI to clearly identify the problem.  In addition, physical therapy is an important part of healing.

You should be able to fully recover and resume your normal activities.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
http://www.theTampaPodiatrist.com
http://www.TampaCryosurgery.com