Posterior ankle decompression- Open technique surgical technique
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Posterior ankle impingement presents with postero-medial or occasionally postero-lateral ankle pain whilst the foot is in positions of full plantar-flexion (such as kicking a ball , dancing en-pointe or descending an incline). There are often no symptoms referable to the joint outside these activities.
It is a condition which not only occurs as a result of repetitive athletic activity but can complicate an ankle inversion injury which usually has a component of forced plantar-flexion as well as inversion.
Irrespective of whether the MRI findings demonstrate bony impingement it is worth commencing interventional treatment with an ultrasound guided injection into the soft tissue envelope posteriorly. This will target the Flexor Hallucis Longus tendon sheath behind the ankle as well as the posterior ankle joint capsule and joint.
The operation described here is an open one though the arthroscopic technique is also well established and described by Nick Cullen from Stanmore in another of OrthOracles techniques.
Author: Mark Herron FRCS
Institution: The Wellington Hospital , London , UK.