Sharp Postero-Medial Ankle Pain

Hey guys,

Just saw a patient complaining of a sudden sharp pain in the posteromedial aspect of their ankle following rapid change in direction during wbing. The patient broke their Fibula 6 months ago and has since made a full recovery and returned to playing basketball. Patient reported no pins and needles or numbness. Initially the ankle was pain-free but lately this medial pain has developed. The pain does not always come on with a change of direction and could not be reproduced in the clinic with functional activities (running/jogging with quick changes of direction, hopping from side to side..).

On palpation the patients pain is reproduced very locally just behind the medial malleolus. (only time patients pain was reproduced in clinic)

The patient has painfree FROM of the ankle and strength is the same as the unaffected ankle. Ligament testing revealed no laxity in comparison with the other side and nil pain.

PA accessory glide + subtalar accessory movements were similar to other side in terms of stiffness and end feel, no pain elicited.

I did notice in standing/walking the patient excessive subtalar pronation (thinking potentially could be overloading tibialis posterior?? But what would explain why the pain is sharp with change of direction only and then dissappears). There is no neural signs so ive discounted tarsal tunnel syndrome (plus the pain pattern doesnt fit with this).

Suggestions much appreciated?

is there inflammation in his or her medial malleolus? have the patient an x-ray may there is someething wrong with the bones as well..

nil inflammation....only original x-rays from last year when she had the # Fib...but if pain persists i think another x-ray is definately warranted to clear the medial malleolus and articular surfaces of structural damage. cheers for that