Posterior capsule injury

Posterior tibiofibular ligament is a thickening of the posterior capsule.

Findings

There is a history of an impingement mechanism, such as an inversion sprain of the ankle with plantar flexion, a foot forced into plantar flexion by kicking a ball or having the kick blocked, a sudden stop, which drives the heel into the ground, or a sudden drop onto the heel, such as an unforeseen step down, missing the kerb or a step. The ankle is swollen, with bruising on its lateral, medial and posterior aspects. Standing on tiptoe is painful and the calcaneotibial compression test is positive. A soccer player can side-foot and chip the football, but is not able to drive or volley the ball.

Cause

A compression injury between the calcaneum and posterior aspect of the tibia that bruises the structures that lie at the back of the ankle.

Treatment

This is as for bilateral bruising of lateral ligaments of the ankle:

a)      Electrotherapeutic modalities to settle inflammation, such as shortwave diathermy and interferential.

b)      An injection of cortisone around the posterior capsule, posterior tibiofibular ligament any deep structures at the back of the ankle.

Sports

a)      Ballet and high jump force this abutment of the calcaneum with the posterior structures of the ankle. The dancer should avoid pointes, but may be able to handle quarter and demi-pointes. This impingement problem settles so rapidly with a cortisone injection that high jumpers are not “out” for long.

b)      Footballers can train, and utilize the kicking ladder, with side-foot and chipping, but can build into the drive/volley only as the injury improves. Strapping to prevent forced plantar flexion may help, but it is not difficult to apply.

c)      Checking suddenly at field hockey, or stretching for a drop shot in squash and badminton.

d)     Stamping the heel down during a squash shot produces posterior compression.

This is often the persistent pain, several months after an ankle injury has occurred, and it may be cured in 2-3 weeks or less with one or two steroid injections into the posterior structures around the talar and subtalar joint. It is often misdiagnosed as an Achilles problem, as both these problems have pain or rising to tiptoe, but achillodynia does not have a positive calcaneotibial compression test.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English