This case was referred to me as the patient has had a long history of anterior ankle pain with chronic ‘tight’ right ankle.
The patient has been trying for many years to have the anterior pain resolved and regain pain-free motion. Many stretching programs have been attempted. However, the patient felt the ankle was stiff, and on ankle stretching exercises, she was sure she could feel a firm and hard sudden block; however, she was advised to stretch through it by her physiotherapist.
She has also had an unsuccessful arthroscope that did not resolve her pain or allow pain-free dorsiflexion.
Her skilled podiatrist suspected there might be a bony block and hence referred the patient for X-rays, including forced dorsiflexion and ultrasound assessment.
The below images confirm that the patient and the podiatrist were correct. The X-ray imaging below shows the anterior tibial spurring that has irritated the superior talus. This repetitive irritation has produced synovitis that was also kicked up on an ultrasound carried out on the same day as the X-rays.
This is relatively straightforwardly fixed surgically with a small lateral incision into that lateral ankle gutter, slightly superior to the ATFL. This will allow me access to the anterior ankle to clear the synovitis and remove the spurring.
This relatively straightforward procedure should relieve pain, slow the process of osteoarthritis/osis, and regain range of motion. The recovery process for this is also relatively quick, as we want instigation of range of motion and proprioception exercise as soon as the wound has healed.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.
Also read:
Is it posterior tibial tendon dysfunction?
(This content is intended for healthcare professionals only)