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Talofib lig tear with avulsion

Discussion in 'Biomechanics, Sports and Foot orthoses' started by RachWadd, Nov 24, 2015.

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  1. RachWadd

    RachWadd Member


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    Hi all,

    I have a 43YO female patient with Type I diabetes that presented with a lateral ankle injury sustained 4/12 ago.

    The injury occurred when the patient was o'seas the day before she was due to partake in a week long walk. The area was iced but certainly not rested as she continued with her European holiday for another few weeks.

    Upon returning home, she was referred by a physio for ultrasound that showed a Grade 2 tear with avulsion of the talofib lig (which, at this stage was 6/52 following the incident). Physiotherapy continued for 6/52, at the end of which the patient reported no improvement to discomfort so stopped going.

    When she saw me for her 6/12 diabetes assessment and general check she reported no cessation in lateral ankle pain and some swelling. The symptoms aren't severe, just annoying. I referred for a second ultrasound which showed similar findings to the previous scan (done 3/12 ago).

    My questions are these:
    Can we expect any healing at this late stage?
    Is the fact that the patient is diabetic having an impact on the healing (current vascular and neurological findings unremarkable) or is this lack of healing common with this type of injury + length of time before treatment sought?
    Is surgical intervention recommended or are conservative measures successful?
    Prolotherapy/PRP successful?
    Any other treatment recommended?

    Thanks for your time,

    Rachael
     
  2. I would recommend a Surg consult, I would it not expect any improvement now , just a worsening , if she is healthy and well controlled Diabetic she will be fine, but if she starts to have issues with her ankle and excise levels are reduced then it might be more of an issue than just a painful ankle.

    She will need lots of post op care and rehab and probable a new device on the affected side
     
  3. efuller

    efuller MVP

    Have you gotten x-rays or an MRI yet? What hurts? anatomically, activities, motions, positions etc. Verify the diagnosis. An ultrasound may not be the best method for assessing an avulsion fracture of the tibia. She must be one tough woman if she was able to walk a week with an acute avulsion fracture.

    Eric
     
  4. RachWadd

    RachWadd Member

    Thank you both for your input.

    Some further information:
    Pain is experienced on supination + walking down stairs + wearing any type of heeled shoe + palpation of the talofib. lig. and calcaneofib. lig. + long periods of weightbearing. There is some mild local swelling around the anterior/inferior aspect of the lateral malleolus.

    I can vouch for the patient's toughness - she was going on that walk no matter what!

    I will refer for x-rays and then on to a pod surgeon for further imaging and advice.

    I will post an update when I can.

    Thanks again

    Rachael
     
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