Among patients requiring surgical treatment, there could be indications for arthroscopic treatment. We performed excision of the ossicle (and repair or reconstruction of the lateral ligament of the ankle) in other cases, especially when the patient desired to return as early as possible to sports activity. We selected fusion of the ossicle in cases where the size of the ossicle was relatively large and the patient was young (before completion of epiphyseal closures) and achieved high success of bone union. In operative treatment, excision of the ossicle (and repair or reconstruction of the lateral ligament of the ankle) and fusion of the ossicle in open treatment are performed, and good results are usually obtained. However, surgical treatment can be required for cases which resist nonoperative treatment and for which symptoms recur. ![]() In general, nonoperative treatment should be chosen first (two to four weeks of rest with restricted weightbearing on crutches or immobilization). Lateral ankle pain is believed to be caused by traction stress of the ossicle from the attached ligament or by surrounding synovitis and hypertrophic soft-tissue impingement. However, they can become symptomatic during trauma or overuse because of exercise, and require treatment. The presence alone of separated ossicles does not always cause symptoms. These ossicles are found in 1 % of the human population, and are a result either of an unfused accessory ossification center or an avulsion fracture of the anterior talofibular ligament. ![]() Among patients who complain of pain at the tip of the lateral malleolus after ankle sprains or sports activity, separated ossicles (“os subfibulare”) are often noted.
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