Journal of Medical Ultrasound

IMAGING FOR RESIDENTS – QUIZ
Year
: 2022  |  Volume : 30  |  Issue : 3  |  Page : 242--243

A triathlete with lateral retromalleolar pain


Édouard Giroux1, Martin Lamontagne2, Mathieu Boudier-Revéret2,  
1 Department of Family Medicine, Université de Montréal, Montreal, Canada
2 Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada

Correspondence Address:
Dr. Mathieu Boudier-Revéret
Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, 3840 St. Urbain St., Montreal, QC, H2W 1T8
Canada




How to cite this article:
Giroux É, Lamontagne M, Boudier-Revéret M. A triathlete with lateral retromalleolar pain.J Med Ultrasound 2022;30:242-243


How to cite this URL:
Giroux É, Lamontagne M, Boudier-Revéret M. A triathlete with lateral retromalleolar pain. J Med Ultrasound [serial online] 2022 [cited 2023 Jan 30 ];30:242-243
Available from: http://www.jmuonline.org/text.asp?2022/30/3/242/322286


Full Text



 Section 1 – Quiz



 Case



A 47-year-old triathlete with pain in his lateral left ankle was referred for a musculoskeletal ultrasound evaluation. He had no past medical history. Eighteen months prior to consultation, he had a sudden onset of sharp pain in the retromalleolar area while climbing a hurdle during an obstacle race. No swelling was noted. Physiotherapy and foot orthosis did not help. He was not able to resume running. Twelve months after the injury, a magnetic resonance imaging (MRI) revealed mild tendinopathy and tenosynovitis of the fibular tendons and lateral malleolus bone marrow edema. A corticosteroid injection of the fibular sheath done under ultrasound guidance was performed and did not help him. Upon review of the MRI imaging, there was a suspicion of longitudinal split tear of the fibular brevis tendon and a retinaculum tear.

On physical examination, he had bilateral pes cavus. There was no swelling or atrophy in the ankle region. Gait and ankle range of motion (ROM) were normal. Tiptoeing and jumping reproduced his left lateral ankle pain. He did not have pain on isometric testing of the fibular brevis tendon and mild discomfort on isometric testing of the fibular longus tendon. He had mild pain upon palpation of the retromalleolar area, as well as at the attachment of the fibular retinaculum on the posterolateral malleolus. There was a doubt regarding possible subluxation of the fibular tendons with resisted active eversion.

Static and dynamic ultrasound (Philips Epiq 5, 7–18 MHz multifrequency linear probe) of the fibular tendons was performed [Video 1] [SUPPORTING:1]. The readers should analyze [Figure 1] and [Figure 2] and Video 1 to define all the abnormal findings.{Figure 1}{Figure 2}

 What is your diagnosis?



Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.