A 22 year old presented with complaints of ankle pain after rolling the left ankle the day before.
There was pain around the outside of the ankle joint. They were unable to completely weight bear through the foot.
Reviewing the xray indicated a slight discrepancy in the anterior process of the calcaneum.
This was confirmed when performing an ultrasound onsite at the ankle, foot and orthotic centre.
As this was a a small, non-displaced fracture it is best treated non-operatively.
Initially the foot was immobilised in a CAM walker for four weeks with weightbearing as tolerated. After the four week mark they converted into a lace up ankle brace as needed for support.
If this was a large displaced fragment or fracture of a significant portion of the calcaneocuboid joint it may have required surgical fixation. Fixation of the fragment is necessary to restore alignment of the articular surface to restore anatomy and minimise the risk of arthritis.
Non- unions of the anterior process can occur, with a persistent fragment seen on follow-up X-rays. If there is no symptoms, then there can be a return to activities as tolerated.
Those patients with persistent symptoms are considered for excision of the fragment and repair of the bifurcate ligament.
