Posterior ankle pathologies

Red flag screening

• Sinister pathology
• Emergency conditions such as acute tendon rupture or fracture
• Osteomyeltis/infection
• Inflammatory arthropathies.

Consider

• Mechanism of injury
• Duration and severity in symptoms
• Change in symptoms.

Limitation of function
Swelling pattern and severity.

• Thomsons test: squeeze calf to see if foot plantarflexes to indicate achilles tear/rupture
• Assess flexibility in triceps surae
• Intermittent pain related to exercise or activity
• Stiffness upon weight bearing after sleep or rest
• Pain is relieved with gentle exercise
• Resisted plantarflexion and passive dorsiflexion increases pain
• Painful to tip-toe or climb stairs
• Decreased plantarflexion strength on affected side.

• Diagnostic ultrasound will aid assessment of the achilles and bursa
• Plain film X-ray will assess haglunds pathologies
• Blood work if inflammatory arthropathy suspected.

• Kagers fat pad
• Bursitis
• Posterior ankle impingement
• Haglunds deformity
• Inflammatory arthropathy
• Achilles tear/rupture.

Patient education and self management advice, with supporting literature including:

• Weight management advice if appropriate
• Activity modification and management advice
• Analgesia & non-steroidal anti inflammatory drugs as appropriate
• Exercise prescription
  • Calf/achilles stretches and loading
  • Balance and proprioception
• Footwear advice
• Avoidance completely flat footwear, up to 1.5 inch heel height acceptable.

• Failure of first line treatment
• Ambiguous diagnosis
• Worsening symptoms.