Description of patient (type of occupation, indication of age, intensity of sport):
The patient is a boy, 16 years old, he plays tennis with a sequel of bilateral clubfoot operated years ago by another surgeon, with valgus malalignment in both feet.
History and previous treatment:
He has pain when he plays sports, 3 times a week, no swelling.
Current complaints:
He can´t play tennis without pain.
Physical examination:
Ankle valgus deformity sequela of a lot of surgeries about his club feet. No laxity and no instability.
Radiology:
X-ray:
[Picture 1 = 2]
lateral weightbearing X-rays
Additional investigation (CT/MRI):
[Picture 3]
Coronal view.
[Picture 4]
Saggital MRI shows osteochondral lesion.
Images:
Case summary:
Patient of 16 years old that he can´t play tennis without pain, previously he was operated a lot of times, he would like to improve the symptomatology.
Question(s) to this case:
I would like to know which is the best alternative:
1. Arthroscopy and treating the osteochondral lesion and calcaneous osteotomy to correct the malalignement.
2. Conservative treatment and change sport.
3. Another alternative.
Expert:
Difficult case. Change sport is probably best option. Otherwise indeed calcaneal osteotomy and possibly OCD treatment. Since it looks a large lesion I would strongly consider Lift, Drill, Fill and Fix the OCD.