title: Musculoskeletal management of a patient with a history of chronic ankle sprains: identifying rupture of peroneal brevis and peroneal longus with diagnostic ultrasonography.
abstract: OBJECTIVE
  The purpose of this case report is to describe the use of mobilization and eccentric exercise training for a patient with ankle pain and a history of chronic ankle sprains and discuss the course of diagnostic decision making when the patient did not respond to care.
  
  
  METHODS
  A 48-year-old police officer who had sustained multiple ankle sprains throughout his life presented with pain and restriction in his ability to walk, run, and work. The Global Rating of Change Scale score was - 6, the Numeric Pain Rating Scale score was 7/10, and the Lower Extremity Functional Scale score was - 33. Palpation of the peroneus longus and brevis muscles and inversion with overpressure reproduced the chief concern (Numeric Pain Rating Scale 7/10). The patient was initially diagnosed with chronic peroneal tendinopathy.
  
  
  RESULTS
  Treatment included lateral translation mobilization of the talocrural joint combined with eccentric exercise using an elastic band for the peroneal muscles. The patient reported improvement in pain and function during the course of intervention but not as rapidly as expected. Therefore, follow-up ultrasonographic imaging and radiography were performed. These studies revealed partial rupture of the peroneal brevis muscle and total rupture of the peroneal longus muscle.
  
  
  CONCLUSIONS
  A patient with long-term concerns of the foot complex with a diagnosis of peroneal tendinopathy showed slight improvement with eccentric exercises combined with manual therapy of the talocrural joint. After a course of treatment but minimal response, a diagnosis of tendon rupture was confirmed with diagnostic ultrasonography. Clinicians should be aware that when injuries do not improve with care, tendon rupture should be considered.
authors.affiliation: Private Practice, Manuele Fysiotherapiepraktijk ParaMed, Noord-Scharwoude, The Netherlands.
authors.forename: Dick B
authors.initials: DB
authors.lastname: Bruin
authors.affiliation: Professor, Department of Movement Science University of Applied Science Osnabrück, Osnabrück, Germany.
authors.forename: Harry
authors.initials: H
authors.lastname: von Piekartz
keywords: Ankle injuries; Musculoskeletal manipulations; Resistance training; Tendons/pathology