HISTORY
Most people remember Curt Schilling’s performance in Game 6 of the 2004 ALCS (i.e. “The Bloody Sock”: http://wapc.mlb.com/play/?content_id=4126739). He had to have surgery prior to the game to prevent the peroneus longus tendon from ‘snapping’ over the lateral malleolus while pushing off the mound (ankle plantar flexion and eversion).

SUBJECTIVE
A 42 year old male presented to the clinic with ‘snapping’ on the outside of his ankle with running. He states he has sprained the ankle ‘pretty bad’ several times in the past. He reported ‘sharp pain’ when it would snap which would happen with almost every step. He felt the pain had worsened as of late because of training for a 1/2 marathon (13.1 miles).

OBJECTIVE
Negative orthopedic testing. Motion palpation revealed excessive subtalar inversion with no end feel; no subtalar eversion with hard end feel. Ankle plantar flexion was limited. Unable to reproduce symptoms clinically. Proximally, he had limited hip extension on the same side of the affected ankle. Tender to palpation along peroneus longus tendon.

ASSESSMENT
Mobilized the subtalar joint and talus via distraction into eversion. Performed instrument assisted soft tissue mobilization that revealed significant adhesions along the medial gastrocnemius which was causing the talar inversion. Improved hip extension via post-isometric relaxation of the hip flexors and mobilized the SI joint via distraction.
Performed kinesiology taping with Rocktape to maintain the peroneus longus tendon posterior to the lateral malleolus (see images).

FOLLOW-UP
Patient ran 7+ miles with no pain. After the tape came off, snapping returned but was not as bad. Have performed the taping 3 times now with decreasing amounts of tension. Patient has been instructed on HEP of hip abduction with red Theraband around his midfoot (this created strength along the lateral Anatomy Trains: gluteus medius and peroneals via active hip abduction while the ankle performs isometric eversion).