posterior ankle impingment

[Open Mind]

Hi I've often read various threads but am slow typist so this is the first time I've posted anything.

I have an elite swimmer with posterior ankle impingement. They have previously had a corticosteroid injection (1 yr ago on the os I believe) & was asymptomatic for approx 9 months.

Pain is main symptom but is generally intermittant and only with higher sets & with fins. Reproducing symptoms clincally has also been intermittant (even poolside!).

Initial clinical problems at the time, lost about 20% WB DF - accessory loss was mainly TC & tibfib with some f/footsome, PF was full, neural differences with SLR & Slump bias' (but not reproduction of sx) R vs L, palpation tenderness was intermittant & not they think site of orignial problem or injection site. Is also tender (again intermittantly) around posterior fibula / sural nerve.

L/s, SIJ testing is normal (to me anyway!). Has just finished a 14 day NSAIDs course (surgeons suggestion). Has seen team physician who was happy with what approach & are reviewing with surgeon in a few days.

Athlete isotherwise fit & healthy with no medical conditions.

Have treated it based on what you read above, restored DF, some neural stuff & is probably getting along at about 90-95% - which as you would expect is not enough function for level of athlete.

Have worked with other top athletes with similar issues (although not swimmers) & have generally speaking got them through, this one is proving a little tougher!

Just wanting to get thoughts / ideas of other therapists who may have dealt with similar things & or elite type swimming problems.
Thanks

[C1086]

If your swimmer definitely has posterior ankle impingement,then they are still aggravating it when not training and competing. Look at there life outside of swimming. Do they require orthotics ? look at footwear. to decide if orthotics are appropriate, I would tape (Zinc Oxide) foot to support it like an orthotic and tell them to keep it dry for 48 hours,otherwise carry on normally. Wear trainers with shoelaces done up (you may need to demonstrate this !), no slippers or bare feet at night.Then get them back and find out if symptoms have reduced or gone, if symptoms have eased I would be suspicious of a foot biomech prob. You must start somewhere, so start and do this first then if it draws a blank, keep looking as the answer is standing right infront of you.

Regards,

C

[Open Mind]

Thanks for advice
We have been down this route.

[psychophysio]

I developed a posterior impingement problem after a 4 ligament ankle sprain. After PT initially and plateauing I was referred to a surgeon and then PT again and then a Sports Dr and then another surgeon who finally removed an os trigonum and another jagged bit of bone from my ankle joint. I found cortisone didn't make a difference prior to the surgery (I had 2 injections before he sent me to a surgeon again). Post-op things are better and I had another steroid injection when things flared up which worked well to control pain.

I found swimming really sore because the motion constantly put my ankle in that PF and impingement position and it was much worse with fins. I had some calf shortening after the injury too and lotsa calf stretches helped to restore my biomechanics and gap the posterior part of the joint a bit.

I would imagine that if he wants to continue to train and compete at elite level Rx is going to have to be symptom management and maybe semi-regular steroid injections - an opinion from a sports physician about surgical management could be useful too.