Orthopedics Today, August 2017
Andrew R. Hsu, MD
A 17-year-old female high school soccer player with no medical comorbidities presented to clinic with right ankle pain that progressively worsened in the past 6 months. For 4 years, she had been diagnosed by her primary care physician and athletic trainers as having recurrent ankle sprains and ankle instability. The patient had been treated with multiple rounds of orthotics, ankle bracing, tall controlled ankle motion (CAM) boots, physical therapy and NSAID, with minimal benefit. The patient reported pain particularly with cutting maneuvers during soccer and when she tried to move her ankle side-to-side.
On physical exam, the patient was 5 feet 6 inches tall and weighed 110 pounds. She had diffuse pain and swelling along the medial aspect of her foot and ankle. She could not pinpoint the exact area of her discomfort, but she had worsening pain with subtalar joint passive range of motion (ROM). Standing alignment showed the patient had a rigid flatfoot deformity with mild forefoot abduction. She had full ankle ROM with mild pain over the anterior talofibular ligament, but there was no gross ankle ligamentous instability. Radiographs of the right ankle were obtained for further evaluation (Figure 1).