A 39-year-old male construction worker presented to the foot and ankle orthopaedic clinic with posteromedial left ankle pain following a minor football injury 6 months ago. He described a football tackle to his left ankle; subsequently, the ankle became swollen and painful. He did not seek immediate medical attention after the injury. Due to ongoing pain symptoms of PAIS, he was unable to carry on with sporting activities. On examination, his ankle was not swollen, and he had a palpable posteromedial lump that was tender. His pain film radiograph demonstrated a prominent posterior process of the talus that was fractured and displaced, but this had been misdiagnosed as an os trigonum (see Figure 5). He underwent an MRI to evaluate this lump and determine the relation to the medial neurovascular structures. The scan demonstrated a posteromedial tubercle fracture fragment medial to the FHL tendon. There was also an associated os trigonum. Interestingly, the MRI report did not describe the posteromedial tubercle fracture fragment that was the palpable mass (see Figure 6). This fragment was painful and restricted his mobility. He underwent operative intervention with open excision of the posteromedial fracture fragment and os trigonum. This was achieved through a posteromedial ankle incision where the neurovascular bundle and FHL tendon were seen and protected. He was followed up in 6 weeks where his PAIS symptoms had improved, and he was commenced on physiotherapy.