Os trigonum/posterior talar process injury in 10 year old

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Hi all,
Interesting case for you all and I would appreciate any feedback/insights/recommendations.
10 year old male Sprinter presents to clinic 3 weeks after a forced plantarflexion injury whilst playing football. The posterior ankle was swollen after injury and icing and rest has settled the odema. His presenting complaint was one of inability to run more than 200m without experiencing posterior ankle pain.
Examination revealled tenderness with deep palpation of the medial posterior talar proces. Pain with resisted plantar flexion and resisted hallux flexion. Inability to 1 leg heel raise.

Xray reveals a small well corticated eliptical bone island at the posterior aspect of the talus.( I have tried to upload a photo but am unsure as to if it has worked)

My questions are firstly pathology...What is going on am I looking at a posterior talar process fracture( my bet) or an early ossification of an os Trigonum and possible sydesmotic disruption leading to the pain?

Secondly treatment options. My plan was to place patient in cam walker for 3-4 Weeks with a compression bandge followed by a rigid rocker sole and rehab exercise with a gradual return to running in 6-8 weeks dependant on progress. Your thoughts is this overkill??

 

I would immobilise in a CAM walker for 6 weeks.

Then consider small dose of long acting steroid to the area under US guidance if still symptomatic after this.

Consider surgical excision if symptoms fail to settle over 6-12 months.

LL