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Posterior Ankle Impingement


Here’s the latest #Advent instalment in our series. A daily evidence-based info-hit from the North Light world of physical health, wellbeing & performance! This is a day late-you know, like when you forget to open your calendar on one day, so you get 2 the following day? (Another instalment to uploaded earlier this afternoon!!)

Also look out for an announcement in the next couple of days in the run-up to Christmas – you can be involved, as long as you’re not on the naughty list!.

I had the privilege recently of attending the operating theatres at Leeds Nuffield hospital to observe Mr Mark Farndon carry out a hindfoot endoscopy (keyhole surgery approaching from the back of the ankle). These opportunities are a key part of the ongoing development of our private service provision at North Light Physio, our individual professional development and in our responsibilities to the sporting partners we provide to. Critically, a great means of reinforcing well-grounded knowledge, and developing relationships with surgical staff – collaborative working being critical to patient care.

The case in question related to a cricket player (bowler) complaining of pain at the back of the (in this case, left) ankle on delivery of the ball. See image of the front foot below, and how the shin bone is angled backwards against the back of the foot/ankle (forced weight-bearing dorsiflexion).

This is not uncommon, but we weren’t able to settle his symptoms sufficiently with Physiotherapy alone. On referral for imaging, an os trigonum (accessory bone at the back of the Talus) was demonstrated- see images below.

The consequence is the likelihood of impingement in the back of the ankle, due to a physical lack of space – the joint lining can become inflamed, and swelling can build. The long tendon flexing the big toe (Flexor Hallucis Longus, FHL), can also become involved, given its proximity.

In this particular case, following surgery to remove the Os Trigonum, recovery has been excellent, and as we speak, the player is taking a full part in pre-season training, with no symptoms at all.


So, what did I learn from this case?

1. As good as we are as Physiotherapists, we can’t solve everything through Physio – knowing when to refer on is critical. The skill of knowing when to refer-on takes years of exposure – especially with conditions which do not appear regularly in our practice.

2. Reinforced my strongly-held belief in team-working across specialities- and how vitally important this is outside of the hospital setting, particularly when working in different geographical areas to the surgical team. Being there to discuss the rehab with the surgeon during the procedure is completely invaluable.

3. Knowing the pathology, the surgeon, the individual, and the feeling from the surgeon as to how well the procedure went, all give us a great advantage in preparing for, and delivering high-quality and timely ankle rehabilitation, to allow a speedy recovery!

An informative case to work on, and rewarding to see excellent progress!

Remember- get in touch below if you want our advice with your ankle problem!


Christopher Liversidge (MSc, BSc (Hons) MCSP, SRP) is Practice Principal at North Light Physiotherapy Associates, Huddersfield, UK.  Click here to contact Chris, or call 08451770780

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