Dear Karen,
I believe that posterior impingement will be the correct diagnosis,
but that in association there may be some retrocalcaneal bursitis.
Have you have the ankle x-rayed?
You want a lateral view in neutral and plantarflexion.
Observe the posterior tubercle of the talus. This is frequently
an unfused ossific centre and is called "os trigonum". Approx. 10%
of the population have this anatomical variant.
Treatment should consist of NSAIDS, mobes of the ankle joint (try
distraction with plantar flexion, or ant. talar glide with PF). I don't
believe you should induce pain with the mobes, contrary to another
response I read. you could also tape her when she plays, to prevent
end range plantar flexion. YOu need to let the synovium settle, it
is highly vascular and highly responsive to irritation.
Corticosteroid injection is probably the best idea, because from
clinical experience and according to Brukner and Kahn this injury often
fails to settle with conservative management. The reason I believe
is that the people that get it (eg. ballet dancers) are always in a PF position
so much, and it is so hard for them to have complete rest from their
sport / activity.
Scott Epsley
Physiotherapist
Brisbane,Australia.
--
On Sun, 13 Feb 2000 16:27:14 Karen Yeomans wrote:
>Dear All,
>
>I am currently perplexed by recurrent Achilles pain in the right ankle of a GB under-water hockey player. She is 22 years old and about to graduate from a BEd PE degree. The pain only occurs when she is swimming with fins. She has not recently changed them. I can reproduce her pain with both active and passive end-range plantar flexion. No tenderness or palpable thickening evident. Gait pattern NAD. She does have skin redness posterior heels bilaterally from the fins rubbing. Accessory movements full range and pain free. I've advised her to speak to her coach regarding technique etc. A colleague has suggested a change to shorter fins for training to reduce the torque at the ankle.
>
>Any suggestions for treatment would be very gratefully received.
>
>Many thanks
>
>Karen Yeomans
>Peterborough
>
MailCity. Secure Email Anywhere, Anytime!
http://www.mailcity.com
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|