4.4 of 21 Ratings
A 23-year-old soccer player with a history of multiple ankle sprains presents with posterolateral ankle pain that has been present for the past 3 months. On physical exam, the patient has pain over the posterolateral ankle with plantar flexion, but no pain is elicited with combined passive dorsiflexion and eversion of the ankle. He denies any numbness or tingling in his foot or sensation of ankle instability. The pain has been managed with rest, physical therapy and intra-articular steroid injection with only marginal improvement. A current MRI is shown in Figures 1 and 2. What is the best next step?
Peroneal brevis tubularization
Arthroscopic excision of os trigonum
Flexor hallucis longus (FHL) tendon debridement
EMG to evaluate for tarsal tunnel syndrome
Subtalar loose body removal
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A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. On physical examination she has no tenderness at the insertion of the achilles tendon at the calcaneus. Radiographs are shown in Figure B and a MRI is shown in Figures C-E. Which of the following options is the most appropriate next step in treatment?
Referral to an orthopaedic oncologist for biopsy and staging
Arthroscopic Haglund deformity excision and debridement of achilles tendon
Open os naviculare excision
Arthroscopic os trigonum excision
Posterior tibial tendon debridement