Sunday, May 15, 2011

Posterior Impingement of the Ankle

Patients with posterior impingement of the ankle oftentimes complain of pain in the posterior, or back of, the ankle. There may be an associated snap or catching sensation along with it, which may be caused by the tendon which lies next to this area, called the FHL (Flexor Hallucis Longus). Along with physical examination and plain x-rays, an MRI may be useful in making the diagnosis. The nonoperative treatment typically consists of NSAIDS, injections, and rest. If these fail, an endoscopic surgical technique may be used to remove the excess bone (Os trigonum or trigonal process) with release of the FHL (Flexor Hallucis Longus) tendon. This endoscopic technique is a minimally invasive technique that has the potential advantages of less bleeding, faster recovery, less scarring, and less pain.

Internal Snap of the Psoas (Iliopsoas) Tendon

The treatment for internal snapping of the hip may consist of a psoas tendon release in those patients who have failed nonoperative treatments and who have persistent pain. Nonoperative treatment for an internal snap typically consists of injections and avoidance of repetitive snapping if possible. Patients typically complain of a snap or click in the hip and on physical examination the snap can often be reproduced. Oftentimes there are other associated abnormalities in the hip that may be causing pain and that may need to be addressed. If there is no pain associated with the snap, typically no additional treatments are necessary. I have recently added a video to my website through youtube that demonstrates the arthroscopic surgical technique. Once the joint has been accessed arthroscopically, the procedure typically takes about 5 minutes to complete.