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Background: Os trigonum is a common cause of posterior ankle pain in dancers. Ballet specifically requires repetitive ankle plantarflexion and sustained positioning at end range. Those that have os trigonum present may experience pain and limited range of motion. Following excision of an os trigonum it is important to gradually progress a patient through return to dance activities. The purpose of this case report is to describe the rehabilitation progression of an adolescent pre-professional dancer following bilateral os trigonum excision. Case Description: An adolescent pre-professional dancer with two-year history of posterior heel pain with bilateral os trigonum present that led to surgical removal. Post-surgery, the patient was seen for four months for return to full dance participation. Interventions: Interventions included therapeutic exercise, therapeutic activities, neuromuscular re-education, and manual therapy specific to dance related goals. Outcomes: The patient was able to return to modified dance activity six weeks post-operatively and begin return to pointe work at nine weeks post-operatively with full participation in performances at four months. Discussion: It is important to consider multiple aspects in regard to rehabilitation including pre-surgical level of function, hypermobility, and relevant co-morbidities in order to safely return a patient to full dance participation.