Gday ALL
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29 Y/O Male pt presents 6 wks post L inversion sprain. Pt is an amatuer athlete who is extremely fit and has had a history of inversion sprains on L ankle.
Pt has fairly neutral RSCP, Moderate To High Sup Resitance (suprisingly given his Hx of Inv Sprains I assumed it would be low), Average Tib Varum and a history of calf strains and Achilles tendonitis.
Swelling around med/lat ankle has all but completely resolved and pt has been adhering to physio regime of ice, Gentle mobs/ proprioception exercises. Pt has been training (AFL) over last week and experiencing pain even with gentle jogging at the posterior aspect of his heel, deep to his achilles tendon (posterior aspect of Talo Craural Jnt).
Pt experiences pain with both passive Plantar flexion AND Dorsi Flexion. Pain when mobilising Talo Craural Jnt when foot is maximally inverted. Weakness in peroneals was treated successfully using trigger point therapy and cuboid mobilisation.
Pt feels like there is a block when he goes onto toes.
My Differentials include
Posterior Impingement/os trgnm Sx (unlikely due to pain on D/F, but included regardless)
Talar dome lesion (seems more probable)
Scar tissue/granulation secondary to trauama/repair in Post talo Fib Lig
Would appreciate any advice in regards Tx and diagnosis.
If Sx do not begin to ease over next 2 wks Im thinking of ordering an MRI to investigate injury to talar dome, but Im holding off due to prohibitive cost of scan.
Look FORWARD TO HEARING YOUR THOUGHTS.
MrT
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