There are three steps you have to complete to become a professional dancer: learn to dance, learn to perform and learn how to cope with injuries.
Sportspeople, particularly ballet dancers, footballers, and high jumpers, may complain of ankle pain that is not related to an acute ankle injury (Chapter 38). Clinical management is simplified if the presentations are further divided into:
medial ankle pain
lateral ankle pain
anterior ankle pain.
The region that might be considered “posterior ankle” pain is defined as the “Achilles region” in this book (Chapter 37). Note that, in real life, patients present with combinations of pain, such as lateral and anterior pain in soccer players. In those circumstances, the systematic clinical approach outlined below still aids in diagnosis and management.
Clinical experience suggests that the most common cause of medial ankle pain is tibialis posterior tendinopathy.1 Posterior impingement syndrome of the ankle (Chapter 37) may occasionally present as medial ankle pain. Flexor hallucis longus tendinopathy is not uncommon and may occur together with posterior impingement syndrome. In the case of flexor hallucis longus tendinopathy, the patient is often suffering from loud—and painful—crepitation, behind not only the medial malleolus; but also may be projected further down the foot on the medial side. In some cases, patients feel that the crepitation is located in the big toe. The therapist should always look for tendinopathy in the region behind the medial malleolus. Flexor hallucis longus tendinopathy almost always needs surgery, which can be done with the aid of the arthroscope (i.e. hindfoot arthroscopy). Tarsal tunnel syndrome, in which the posterior tibial nerve is compressed behind the medial malleolus, may present as medial ankle pain with sensory symptoms distally. Causes of medial ankle pain are listed in Table 39.1. The anatomy of the region is illustrated in Figure 39.1).
Causes of medial ankle pain
|Favorite Table|Download (.pdf) Table 39.1
Causes of medial ankle pain
|Common||Less common||Not to be missed |
Tibialis posterior tendinopathy
Flexor hallucis longus tendinopathy
Medial calcaneal nerve entrapment
Calcaneal stress fracture
Tarsal tunnel syndrome
Talar stress fracture
Medial malleolar stress fracture
Posterior impingement syndrome (Chapter 37)
Referred pain from lumbar spine
Navicular stress fracture (Chapter 40)
Complications of acute ankle injuries (Chapter 38)
Complex regional pain syndrome type 1 (following knee or ankle injury)
Medial aspect of the ankle
(a) Surface anatomy
(b) Anatomy of the medial ankle
Differentiating flexor hallucis longus tendinopathy from posterior impingement...
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