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A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. On physical examination she has no tenderness at the insertion of the achilles tendon at the calcaneus. Radiographs are shown in Figure B and a MRI is shown in Figures C-E. Which of the following options is the most appropriate next step in treatment?
Referral to an orthopaedic oncologist for biopsy and staging
Arthroscopic Haglund deformity excision and debridement of achilles tendon
Open os naviculare excision
Arthroscopic os trigonum excision
Posterior tibial tendon debridement
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Shows posterior ankle arthroscopy of left ankle following os trigonum excision
Shows an os trigonum of a left ankle viewed with posterior ankle arthroscopy wit...