os with an arse

Middle aged arab male with pain on walking during swing phase of gait and walking down hill of 4 years duration. No gain with conservative treatment.

O/E. Tenderness on the posterior lateral aspect of ankle with minimal pain on Inv/eversion. Pain on plantar flexion and exteranl rotation.

Any options

We did ahind foot scopy as taught by Dr. Van Djik http://www.ankleplatform.com/. The course is rated 10/10. The portals on a horizontal line from tip of the fibula on either side of the Tendoachilles. The posterolateral portal after split and spread technique is aimed towards the first webspace and hit the bone. The posteromedial portal goes perpendicular to the scope in the PL portal and walk on the scope till you reach tip[ and debride the soft tissue till you expose the os , ankle joint and subtalar joint. The os was removed piece meal with a burr, grabber and finally an osteotome to be flush with the posterior tibia. The FHL shown in the pic protects the n/v bundle. stay posterior to it. The relief of symptoms were magical.

This was presented in the Cochin orthopedic meeting By Dr. Rajesh Subash our latest arthroscopy fellow