Posterior ankle decompression- Open 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.
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Question 1 of 14
Posterior ankle impingement is a condition seen most often in which one of the following ?CorrectIncorrect
Question 2 of 14
The symptoms attributable to posterior ankle impingement characteristically include which one of the following ?CorrectIncorrect
Question 3 of 14
A diagnosis of posterior ankle impingement is normally made based on which one of the following ?CorrectIncorrect
Question 4 of 14
Which one of the following is not appropriate initial management of a case of posterior ankle impingement?CorrectIncorrect
Question 5 of 14
Which one of the following is not true of the skin incision used for an open posterior ankle decompression ?CorrectIncorrect
Question 6 of 14
With respect to the deep fascial layer encountered during the exposure which one of the following statements is true of its immediate relations ?CorrectIncorrect
Question 7 of 14
In mobilising the neuro-vascular bundle which one of the following statements is not true ?CorrectIncorrect
Question 8 of 14
Once the neurovascular bundle has been mobilised which one of the following is true about the next stage of the operation ?CorrectIncorrect
Question 9 of 14
Which of the following is not true of the Flexor Hallucis Longus tendon in the context of posterior impingement?CorrectIncorrect
Question 10 of 14
Which one of the following structures is not contributory to and not potentially released or excised during surgical treatment of a posterior ankle impingement ?CorrectIncorrect
Question 11 of 14
Which one of the following statements is not correct about the impinging posterior Talar bone and its removal?CorrectIncorrect
Question 12 of 14
During the post-operative period after an open posterior ankle decompression which one of the following is correct ?CorrectIncorrect
Question 13 of 14
With respect to the published literature concerning open and arthroscopic posterior ankle decompression which one of the following is incorrect ?CorrectIncorrect
Question 14 of 14
With respect to the results of Ultrasound guided injection as treatment for posterior ankle impingement which one of the following statements is not correct ?CorrectIncorrect