THIRD MALLEOLUS INJURY

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Male 32 yr old, is presented with posteior ankle pain, Postactive dyscinesia and remision of pain with NSAIDS, treated by the GP and Orthopedic as a Achilles tendinitis, and prescribed an heel orthosis, no real improvement of the sintomatology. US of the tendon is normal, with no tendinosis and no anomalies in the Kagger space. MRI shows an old osteocondral lesion of the third malleolus.
from a sprain of the ankle
Any advice....
Thanks

 

I not sure what you mean by 'third' malleolus?

Do you mean an os trigonum or old fracture of posterior aspect of talus?

 

A "tri-malleolar" fracture is one involving the medial malleolus, the lateral malleolus and the posterior aspect of the distal tibial plafond or "posterior malleolus".

http://www.wheelessonline.com/ortho/posterior_malleolar_fractures

 

I mean that anatomic structure, the distal posterior plafond of the tibia, he had an ankel sprain about one year ago with no other implication, now he´s got on the zone ( i mean kagger space) and no one can idetified this until a mri is taken, and a intraosseus oedeme is seen.

My doubt is where can i go,
plantar orthosis
Rehab
Taping ( he has got good sensations with them)
Walker etc
any other....

Thank you sincerely