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A 30-year-old ballet dancer complains of snapping and pain behind the medial malleolus, as well as triggering of her great toe. MRI scan is shown in figure A. What antatomic structure is being impinged at the level of the posterior ankle joint?
posterior tibial tendon
extensor hallucis longus tendon
flexor hallucis longus tendon
anterior tibial tendon
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A 24-year-old dancer reports posterior ankle pain when in the “en pointe” position. Examination reveals posteromedial tenderness, no pain reproduction with passive forced planter flexion, and pain with motion of the hallux. What is the most likely diagnosis?
Painful os trigonum
Posterior ankle soft-tissue impingement
Stricture in the knot of Henry
Flexor digitorum longus tendinitis
Flexor hallucis longus tendinitis
A 32-year-old dancer presents with right-sided posteromedial ankle pain. Her symptoms worsen during the "demi-pointe" position. MRI scan is shown in Figure A. Which of the following physical exam findings is most consistent with this diagnosis?
Reproduction of pain with percussion of the posterior tibial nerve
Painful crepitus of tendon with passive motion at great toe
Posterior ankle pain with forced passive plantar flexion
Medial ankle pain with resisted inversion
Foot drop with weakness of dorsiflexion
A 23-year-old professional ballet dancer complains of medial ankle pain when in the en pointe position. Physical exam shows a hyper-mobile ankle with palpable crepitus along the medial ankle with active range of motion of the great toe. Six months of nonoperative management including rest, ice, NSAIDs, and arch support have failed to provide relief. What is the best next step in management?
Decompression of the flexor hallucis longus at the level of the ankle
Decompression of the flexor hallucis longus at the level of the metatarsal
Decompression of the peroneal tendons at the level of the ankle
First metatarsal osteotomy