Taber's Cyclopedic Medical Dictionary

The management of injury to the distal tibiofibular syndesmosis remains controversial in the treatment of ankle fractures. Operative fixation usually involves the insertion of a metallic diastasis screw. There are a variety of options for the position and characterisation of the screw, the type of cortical fixation, and whether the screw should be removed prior to weight-bearing. This paper reviews the relevant anatomy, the clinical and radiological diagnosis and the mechanism of trauma and alternative methods of treatment for injuries to the syndesmosis.

Injuries to the tibiofibular syndesmosis

Managing tendinopathy in season is a challenge for all sports medicine practitioners. Many of the strategies employed to treat tendinopathy in a rehabilitation setting are not suitable because of the time taken to recover. Management strategies that control pain and maintain performance are required. These include load management, both reducing aggravating loads and introducing pain-relieving loads, medications and adequate monitoring to detect a deteriorating tendon. Other interventions such as intratendinous injection therapies and other direct tendon modalities can be provocative at worst and without effect at best. Research to improve the understanding of management in athletes in season is compromised by ethical considerations and access to willing participants. It is likely to remain an area where clinical advances guide future treatments.

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The challenge of managing tendinopathy in competing athletes

Tarsal tunnel syndrome.

Influence of ankle functional instability on the ankle electromyography during landing after volleyball blocking.

Minimally-invasive treatments for chronic Achilles tendinopathy may prevent the need for surgery when conservative methods have failed. Whilst injections have traditionally been used to manage symptoms, recently described therapies may also have disease-modifying potential. Ultrasound provides the ability to guide therapeutic interventions, ensuring that treatment is delivered to the exact site of pathology. Treatments can be broadly categorised according to their intended therapeutic targets, although some may act through several possible mechanisms. In this article, we review the ultrasound-guided techniques currently used to treat chronic Achilles tendinopathy, with reference to the available literature. There is strong pilot-level evidence supporting the use of many of these techniques, although large definitive trials are lacking. An approach towards the management of chronic Achilles tendinopathy is suggested.

Ultrasound-guided treatments for chronic Achilles tendinopathy: an update and current status

Injuries to the foot and ankle are common in elite athletes and may be responsible for prolonged periods of absence from competitive activity. The osseous, articular, ligamentous and tendinous structures of the foot and ankle may be injured in isolation or, more commonly, in combination. Various impingement syndromes of the ankle are described, many of which have characteristic features on imaging. Radiology now plays a crucial role in management of these injuries, not only in diagnosis but increasingly in guiding percutaneous therapies. The plain radiograph still plays a crucial role in diagnosis but is now supplemented with advanced imaging techniques such as ultrasound, computed tomography and magnetic resonance imaging. We present a comprehensive review of the anatomy, biomechanics, imaging and surgical management of foot and ankle injuries and impingement syndromes encountered in the sporting population.

Ne Siang Chew

Papers

Ultrasound-guided treatments for chronic Achilles tendinopathy: an update and current status

Ankle and Foot Injuries