Abstract
CASE HISTORY: The patient is a 13-year-old male who presented to the osteopathic manipulative medicine (OMM) clinic for evaluation of left ankle pain and stiffness. He reported ankle soreness, which he believed is due to extensive participation in soccer and running 2-3 miles daily. He occasionally experiences stiffness in his left knee and left ankle during physical activity, which does not prevent him from participating in athletic activities. He is left lower extremity dominant. He has a history of a grade 1 ankle sprain 2 years prior that was resolved with conservative management. He denied any other instances of major left ankle injuries or derangements. PHYSICAL EXAM: Examination of the left ankle demonstrated a more prominent anterior talus on static palpation and a mild restriction in dorsiflexion on active and passive range of motion testing. He has tenderness to palpation along the lateral aspect of the left knee along the region of the fibular head. No joint swelling or erythema noted in either the left ankle or the left knee. Osteopathic structural exam revealed restriction in dorsiflexion and eversion of the left ankle with an anterior talus as well as a left anterior fibular head with restriction in posterior translation proximally. DIFFERENTIAL DIAGNOSES: Post-ankle sprain capsular stiffness with anterior talus and fibular head; Tarsal coalition; Anterior ankle impingement; Growth plate injury. TESTS & RESULTS: Left ankle x-ray 2 years ago to evaluate ankle sprain and injury. This x-ray was unremarkable and negative for acute fracture. FINAL DIAGNOSES: Post-ankle sprain capsular stiffness with left plantarflexed ankle and anterior talus with concomitant left anterior fibular head. DISCUSSION: The ankle joint is prone to acute and overuse injuries. Inversion ankle sprains are more common and are associated with restriction in posterior translation of the talus. In anterior talus dysfunctions, the talus fails to glide posteriorly during ankle dorsiflexion at the talocrural joint. This causes pain and restricted motion with the ankle favoring plantarflexion. Anterior talus somatic dysfunctions are approximately 12 times more common than posterior talus dysfunctions. In anterior fibular head dysfunctions, the proximal fibula prefers an anterior position and is restricted in posterior medial glide. Anterior fibular head dysfunctions are associated with tenderness to palpation, lower extremity pain, and gait abnormalities. The concurrent finding of an anterior talus with an anterior fibular head is unusual. Due to the reciprocal motion of the fibula, an anterior talus is expected to be paired with a posterior fibular head. OUTCOME OF THE CASE: There was discussion with the patient and their guardian regarding the patient’s diagnosis and suitable treatment strategies for an anterior talus and anterior fibular head. Explanation of OMM and associated risks, benefits, and alternatives was provided. Informed consent was given to proceed with OMM. The patient responded favorably to OMM techniques including: high velocity, low amplitude thrusting on the ankle and balanced ligamentous tension and muscle energy of the fibular head. Home exercises were also provided. He was instructed on how to perform these mobility and strengthening exercises which included ankle alphabet active range of motion, side to side knee swing, and calf stretching seated with his knee straight. The patient was advised to incorporate 1-2 rest days into his training schedule. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Relative rest and gentle hydration post-treatment was recommended. Scheduled return to the OMM clinic in 2 months to evaluate his body’s response to osteopathic treatment and assess for further management.
Recommended Citation
Ward, Stephanie; Naik, Saahil; and Persaud, Rajinder
(2026)
"Unusual Presentation of an Anterior Talus and Fibular Head in a Youth Soccer Player,"
International Journal of Exercise Science: Conference Proceedings: Vol. 2:
Iss.
18, Article 245.
Available at:
https://digitalcommons.wku.edu/ijesab/vol2/iss18/245