Study Design Case study.
Background Patient was a 16 year old elite soccer player, who complained of medial ankle pain, numbness in lower leg and foot, and loss of plantarflexion strength resulting in lost playing time. Mechanism of injury: reports being ‘cleated’ multiple times, has history of multiple ankle sprains, no trauma.
Case Description Patient was seen by author, Clanton TO, and after full workup, was diagnosed with tarsal tunnel syndrome, deltoid sprain, bony oedema to medial talar dome and sprain to anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments. Having failed conservative management, surgical intervention was recommended. Procedure performed: tarsal tunnel release, tenosynovectomy and removal of low lying muscle belly of flexor hallicus longus, and due to marked instability, repair of ATFL with internal brace and secondary repair of CFL. Patient started physical therapy to reduce swelling, restore range of motion and gait. Objective criteria were used to guide rehabilitation from endurance phase to power and agility training. 5 months post-operatively, the athlete completed a battery of clinically relevant, reliable and valid tests utilised to help determine return to sport readiness.
Outcomes The athlete was cleared and successfully returned to club soccer season, committing the following year to a Division 1 program.
Discussion In this case of an elite soccer player with medial ankle pain, it is the authors’ theory that the patient developed tarsal tunnel syndrome due to repeat medial joint impaction injuries secondary to multiple inversion ankle sprains. This is an example of one of the many possible complications associated recurrent lateral ankle sprains in the athlete. Surgical management addressed the medial and lateral pathology in ankle followed by rehabilitation. Objective criteria were utilised to define progress and advance athlete from initial mobility phase to return to sport clearance.
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