Patient name
V.P.
OSSO Case Study · Post-Surgical Recovery
The surgery was done. The pain stayed anyway.
V.P. had already had arthroscopic debridement of her right ankle - and was still at VAS 8, still swollen, still walking with a limp. She was told the symptoms might simply persist. Reassessment at OSSO found chronic anterior impingement with ongoing synovitis, treatable without a second operation. Sixteen weeks later she was walking 2–3 km pain-free.
- Weeks of treatment
- 16
- Further surgeries
- 0
- Pain, VAS
- 8 → 1
- Ankle strength, MMT / 5
- 3 → 4+
Patient and presentation
Age at intake
27, female
Occupation
Profession - placeholderPlaceholder
Condition
Chronic right anterior ankle impingement syndrome following previous arthroscopic debridement, with persistent synovitis and post-operative inflammation
The Full Journey
Patient and presentation
- Problem treated
- Persistent right ankle pain, swelling and stiffness despite previous arthroscopic ankle surgery, causing difficulty walking and returning to normal activities
- Prior recommendation
- Advised that symptoms may continue despite surgery, with limited options beyond prolonged physiotherapy, activity modification and pain medication
- How she found OSSO
- Referral source - placeholderPlaceholder
The OSSO protocol
Persistent Ankle Impingement Protocol. A comprehensive reassessment of the persistent post-operative pain, followed by a targeted intra-articular corticosteroid procedure into the right tibiotalar joint via medial and lateral approaches, to address the chronic synovitis and impingement directly. This was complemented by a structured recovery programme and a graded return to normal activity.
Why reassessment came first The previous surgery had removed the mechanical block, but the joint lining was still inflamed - which is why the pain outlasted the operation. Identifying persistent synovitis as the ongoing driver, rather than assuming a failed debridement, is what made a targeted intra-articular procedure the appropriate next step instead of repeat arthroscopy.
Weeks 1–2 - Reassessment
Clinical reassessment and a short trial of conservative management.
Week 3 - Procedure
Intra-articular corticosteroid procedure performed into the tibiotalar joint.
Weeks 4–8 - Pain and mobility
Marked reduction in pain and swelling, with restoration of ankle mobility.
Weeks 9–16 - Functional recovery
Progressive functional recovery, improved weight-bearing capacity and return to unrestricted daily activity.
Before treatment vs. week 16
At intake
- Pain (VAS)
- 8 / 10, persisting despite previous arthroscopic debridement
- Swelling
- Recurrent ankle swelling
- Range of motion
- Painful terminal dorsiflexion and plantarflexion, consistent with chronic impingement
- Ankle strength (MMT)
- Grade 3/5 - dorsiflexion, plantarflexion and eversion
- Gait
- Antalgic
- Weight-bearing
- Reduced tolerance
- Daily function
- Significant limitation in walking, stair climbing and prolonged standing
Week 16
- Pain (VAS)
- 1 / 10
- Swelling
- Minimal residual swelling
- Range of motion
- Full, pain-free ankle range of motion
- Ankle strength (MMT)
- Grade 4+/5
- Gait
- Restored gait mechanics
- Weight-bearing
- Improved functional loading without impingement symptoms
- Daily function
- Unrestricted activities of daily living
Calf tightness, joint stiffness and dependence on pain medication all reduced alongside these findings.
Treatments Used
Care team
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