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.

Arthroscopy for ankle fractures?

When is ankle arthroscopy recommendable for ankle fractures? There are two randomized studies published on the use of arthroscopy in ankle fractures. One study demonstrated better results in patients who underwent arthroscopy at the time of open reduction internal fixation and the second study demonstrated equivalent results. Based on this data, I do not perform an ankle arthroscopy on all patients who have had an ankle fracture. With patient specific factors also considered, I tend to perform the arthroscopy on higher energy injuries, such as ankle subluxations or dislocations or syndesmosis injuries. At the time of arthroscopy, Ferkel reported a high rate of damage to the articular surfaces following ankle fractures, and my experience supports this fact. At the time of arthroscopy, loose bodies of cartilage alone or a combination of cartilage and bone can be treated, and the joint is looked at thoroughly to identify and treat any other associated injuries. This damage to the inside of the joint can be a cause of chronic pain if left untreated.

David Beckham torn achilles tendon

A few of my patients today wanted to get my impression of David Beckham's injury. Although I know of no specific details regarding his injury, based on the description in the media he suffered a complete tear. A completely ruptured or torn Achilles tendon is typically repaired surgically, particularly in a competitive athlete who wants to regain near normal strength and function. A complete tear of the Achilles treated non-operatively typically results in a more significant loss of strength with push-off as compared to patients who have a repair. Other tears, such as the peroneals or posterior tibial, typically are incomplete tears and are more chronic and slow in their progression. The main advantage of surgical intervention for a completely torn Achilles is restoration of strength and a decrease in rerupture rate, and the main disadvantage is wound breakdowns. Typically, recovery is at least as quick with surgery as compared to casting. Here in South Florida, the majority of these injuries that I have seen have been from tennis, followed by racquetball and basketball. I treated a patient last week from Miami who jumped off of a palm tree backwards.