Posterior ankle impingement in fast bowlers in cricket.

OBJECTIVE To determine common features of posterior ankle impingement in fast bowlers in the West Indies and to compare modes of treatment with respect to return to play without pain. METHODS Retrospective analysis of ankle impingement injuries treated in fast bowlers in the West Indies. RESULTS Six fast bowlers had evidence of os trigonum in the front foot only. Pain was felt on forced plantar flexion and dorsiflexion on front foot landing; no pain was felt with running. Four had large os trigonum on radiographs, and one was only detectable on Magnetic Resonance (MRI) Imaging. The condition resolved in two bowlers with low workloads who had injections with steroid. The remainder had surgical excision which led to recovery. CONCLUSION This injury is being seen increasingly in fast bowlers. Steroid injections are useful in bowlers with low workloads but surgical excision is recommended in bowlers with heavy workloads. Further investigation is required in the biomechanics of bowling to determine the cause for the increase in this condition.