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Posterior ankle impingement syndrome (PAIS) is sometimes complicated by bilateral cases and lateral ankle ligament injuries. Reports on bilateral surgery for PAIS and simultaneous surgery for lateral ankle ligament injury are scarce in the literature. We present a 2-year follow-up of 76 athletic patients who underwent endoscopic hindfoot surgery for PAIS. Patients were divided into those who underwent unilateral or simultaneous bilateral surgery and PAIS surgery alone or simultaneous bilateral PAIS surgery without arthroscopic ankle lateral ligament repair. All patients returned to full athletic activities postoperatively. There was no difference in all subscales of the SAFE-Q score between groups except for mean days after surgery for full return to athletic activities. Simultaneous bilateral surgery and simultaneous arthroscopic lateral ankle ligament repair had no negative effect on subjective clinical evaluation 2 years after surgery in hindfoot endoscopic surgery for PAIS. III, retrospective case-control study. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the presence of adipose tissue surrounding the flexor hallucis longus (FHL) tendon through gross dissection and magnetic resonance imaging (MRI). Grossly, we observed the FHL tendon and surrounding tissues in nine cadavers. Using MRI, we quantitatively evaluated each tissue from the horizontal plane in 40 healthy ankles. Macroscopic autopsy revealed the presence of adipose tissue behind the ankle joint between the FHL and fibula, and horizontal cross-sections showed an oval-shaped adipose tissue surrounding the tendon. The cross-sectional area on MRI was 14.4 mm2 (11.7–16.7) for the FHL tendon and 120.5 mm2 (100.3–149.4) for the adipose tissue. Additionally, the volume of the adipose tissue was 963.3 mm3 (896.2–1115.6). There is an adipose tissue around FHL tendon and maybe this close anatomical relationship might influence the function of the tendon and be involved in its pathologies. [ABSTRACT FROM AUTHOR]

Le syndrome du carrefour postérieur de la cheville (SCP) est la traduction d'un conflit mécanique, parfois aigu mais beaucoup plus souvent chronique, entre les parois osseuses du carrefour et les éléments osseux et tissulaires que l'on y rencontre. Ce conflit survient lors d'un mouvement de flexion plantaire forcé. La compression intéresse le plus souvent des éléments osseux : partie postérieure du talus ou un os trigone, mais aussi des éléments tissulaires : culs-de-sac synoviaux, complexe ligamentaire postérieur. Le tendon du long fléchisseur du gros orteil ou Flexor Hallucis Longus (FHL) peut également être impliqué. L'examen clinique est essentiel pour évoquer le diagnostic de SCP avec le test d'impaction postérieure. L'imagerie va le confirmer. Les radiographies standard sont indispensables ; la tomodensitométrie complète l'étude osseuse et l'imagerie par résonance magnétique va mieux visualiser les éléments tissulaires éventuellement en cause. La scintigraphie couplée au scanner est indiquée en cas de doute diagnostique Le traitement du syndrome du carrefour postérieur est avant tout conservateur, associant repos, immobilisation, infiltrations, rééducation et modifications du geste sportif. En cas de persistance de la symptomatologie, un traitement chirurgical sera nécessaire : résection d'un os trigone ou d'un processus postéro-externe du talus, libération du FHL, synovectomie, selon les structures en cause. Jusqu'à une période récente, ces gestes étaient effectués à ciel ouvert. Actuellement, le développement de l'arthroscopie de cheville permet d'effectuer les mêmes gestes, mais avec une morbidité moindre et une récupération plus rapide. The posterior ankle impingement syndrome is a pain syndrome caused by compression of bony or soft tissues structures in the posterior tibiocalcaneal interval. Overuse injury is more frequent than acute trauma. The impingement occurs during a forced plantar flexion of the foot. It is described in ballet dancers, soccers or football players. The pathology involved mainly the bones structures: posterolateral talar process or os trigonum, but also soft tissues as synovitis and posterior ligaments. The FHL tendon can present a tendinopathy. The forced hyperplantar test is most important for the diagnosis, reprodiucing the posterior pain reported by the patient. Plains radiographs, CT scan will show osseous lesions. MRI will focus on the soft tissue lesions or bone marrowedema. A spect-CT scan may be helpful in case of doubt. The treatment is first conservative: rest, immobilisation, cortisone injection, physicaltherapy and adaptation of the sport activities. Surgery is indicated for recalcitrant pain: excision of os trigonum or prominent posterior process, release of the FHL tendon, resection of scar tissue, depending of the origin of the inpingement. These procedures were commonly performed by posterior open approach, but endoscopic procedure became now the main technic with a less morbidity and a quicker recovery. [ABSTRACT FROM AUTHOR]

Sprains are the most common injury of the ankle joint and the most common traumatic injury of the musculoskeletal system. Ultrasound (US) examination of the posterior ankle joint is a challenge for the examiner. This paper focuses on this difficult area and provides guidance on how to effectively perform US examination of the posterior ankle. [ABSTRACT FROM AUTHOR]

Background: Transfer of a flexor hallucis longus (FHL) tendon can not only reconstruct the Achilles tendon but also provide ischemic tendinous tissues with a rich blood supply to enhance wound healing. This retrospective study aims to investigate clinical outcomes in patients who underwent repair of Kuwada grade IV chronic Achilles tendon rupture with long hallucis longus tendons harvested using a minimally invasive technique. Materials and Methods: 35 patients who were treated for Kuwada grade IV Achilles tendon injuries from July 2006 to June 2011 were included in this retrospective study. The age ranged between 23 and 71 years. The duration from primary injury to surgery ranged from 29 days to 34 months (mean value, 137.6 days). All 35 patients had difficulties in lifting their calves. Thirty two were followed up for a mean 32.2 months (range 18-72 months), whereas three were lost to followup. Magnetic resonance imaging (MRI) showed that the tendon rupture gap ranged from 6.0 to 9.2 cm. During surgery, a 2.0 cm minor incision was made vertically in the medial plantar side of the midfoot, and a 1.5 cm minor transverse incision was made in the plantar side of the interphalangeal articulation of the great toe to harvest the FHL tendon, and the tendon was fixed to the calcaneus with suture anchors. Postoperative appearance and function were evaluated by physiotherapists based American Orthopedic Foot and Ankle Society-ankle and hindfoot score (AOFAS-AH), and Leppilahti Achilles tendon ratings. Results: Results were assessed in 32 patients. Except for one patient who suffered complications because of wound disruption 10 days after the operation, all other patients had primary wound healing, with 28 of 32 able to go up on their toes at last followup. The AOFAS-AH score was increased from preoperative (51.92 ± 7.08) points to (92.56 ± 6.71) points; Leppilahti Achilles tendon score was increased from preoperative (72.56 ± 7.43) to (92.58 ± 5.1). There were statistically significant differences. The result of the total excellent and good rate was 93.8% (30/32). MRI of Achilles tendon showed even signal without evidence of tear or cystic degeneration. Conclusion: Reconstruction of a chronic Achilles tendon rupture with an FHL tendon harvested using a minimally invasive technique showed good outcomes. [ABSTRACT FROM AUTHOR]

A literature review has been undertaken to assess the efficacy of management of Posterior Ankle Impingement Syndrome with an emphasis on sport. The evidence is confined to Level IV and V studies. There is a lack of prospective studies on the natural history of this condition and the outcomes of conservative treatment. Dance dominates the literature accounting for 62% of reported sports. Forty-seven papers have reported on the surgical outcomes of 905 procedures involving both open and artho-endoscopic techniques. 81% of patients required excision of osseous pathology and 42% soft-tissue problems resolving. There is a lack of standardisation of outcome reporting particularly in the open surgery group. However, the complication rates are relatively low: 3.9% for open medial, 12.7% for open lateral and 4.8% for arthro-endocopic surgery. Return to sport appears quicker for all activities in the arthro-endoscopic group but comparison of long term outcomes is more difficult with no evidence supporting superior long term results of one technique over another. Soccer players appear to return more quickly to activity than dancers. [ABSTRACT FROM AUTHOR]

The hallucal interphalangeal sesamoid bone is usually asymptomatic, but it is not uncommon for it to be symptomatic in cases of undue pressure, overuse, or trauma. Even in symptomatic cases, however, patients often suffer for extended periods due to misdiagnosis, resulting in depression and anxiety that can steadily worsen to the extent that symptoms are sometimes mistaken for a somatoform disorder. Dynamic ultrasound-guided evaluations can be an effective means of detecting symptomatic sesamoid bones, and a simple injection of a small dose of local anesthetics mixed with steroids is an easily performed and effective treatment option in cases, for example, of tenosynovitis. [ABSTRACT FROM AUTHOR]

Summary We report a case of flexor hallucis longus (FHL) in which, following a hyperextension injury to the great toe, the patient had a closed rupture of the FHL tendon near to its insertion, which was successfully treated conservatively. There are only five reported cases of closed traumatic rupture of the FHL tendon at different levels and no successful reports of conservative treatment of rupture near to its insertion into the base of the distal phalanx. [ABSTRACT FROM AUTHOR]

Summary: We report a case of flexor hallucis longus (FHL) in which, following a hyperextension injury to the great toe, the patient had a closed rupture of the FHL tendon near to its insertion, which was successfully treated conservatively. There are only five reported cases of closed traumatic rupture of the FHL tendon at different levels and no successful reports of conservative treatment of rupture near to its insertion into the base of the distal phalanx. [Copyright &y& Elsevier]