Synovial Sarcoma (SS) is a rare mesenchymal-origin neoplasm representing about 8–10% of all soft tissue sarcomas (STS). It can arise at any age, but it is typically found in children and young adults, where it has a better prognosis. In general, it is considered an aggressive high-grade malignancy with a poor prognosis and a life expectancy of 5 years, in adult patients. Although lower extremities are the most involved site, the occurrence of SS in the hindfoot area is particularly rare, and only limited data are available in the literature. We present our experience in an uncommon case of high-grade synovial sarcoma occurring in the hindfoot of a 54-year-old Caucasian man. After clinical and instrumental assessments, and a biopsy of the lesion confirming the diagnosis, the patient underwent surgical excision of the tumor mass. A marginal resection of the calcaneus was performed, and coverage of the large skin gap was achieved with an anterolateral thigh (ALT) flap, without recurrence during the follow-up. This study aims to assess our personal experience of a rare case of high-grade SS of the hindfoot. The complex management requires the presence of a reference center for foot and ankle surgery, and a multidisciplinary team that includes expert orthopedic and plastic surgeons, as well as oncologists, to ensure an optimal and correct treatment of the condition.

Background: Tibialis posterior tendinopathy (TPT) or traumatic tears following a lateral ankle sprain are not commonly reported in the literature. The purpose of this study was to report our case of TPT in an athlete who underwent a lateral ankle stabilisation. Case study: A 27-year-old male, elite Gaelic football athlete suffered a non-contact inversion ankle injury. MRI revealed a high grade ATFL tear and minor TPT. The initial management of physiotherapy led rehabilitation was unsuccessful. Consequently, the patient was progressed to surgical management via Brostrom stabilisation. Post-operative protocol was backslab for 2 weeks in a neutral position. The patient subsequently wore a boot for 2 weeks followed by physiotherapy. Therapy consisted of proprioceptive rehabilitation, peroneal and functional lower limb strength training. The patient was re-introduced to a return to run protocol at 5 weeks post-operative. At 8 weeks, the patient returned to sport having successfully passed criteria. However, his progress was limited due to the onset of medial ankle pain. Objective: To treat clinically symptomatic TPT via ultrasound guided injection and progressive strengthening exercises as part of a return to play programme. Discussion: This case highlights the presence of TPT in high grade ATFL tears. TPT should be included within differential diagnosis for persistent medial sided pain following a lateral ankle sprain. Vigilance is required when managing such athletes as MRI findings can be subtle. Clinical assessment with dynamic USS followed by a guided injection may assist in ensuring a prompt return to sport following Brostrom stabilisation.

Fractures of the calcaneus can affect the biomechanics and anatomy of the subtalar joint in different ways. Subtalar distraction arthrodesis has become an alternative technique for correcting the residual hindfoot deformity and specially, for restoring the talus orientation. Additionally, the uncommon posterior approach facilitates the correction of calcaneal height and its axis. Case A 48-year-old male with a history of bilateral calcaneal fractures due to a three-meter fall. Conservative management with cast immobilization and non-weightbearing was decided. After two years of follow-up, the patient developed a right painful flatfoot even though the physiotherapy. Radiographic results showed dorsal flexion of the talus with depression of the calcaneus. Computed tomography showed a severe post-traumatic subtalar arthropathy. It was decided to perform a subtalar arthrodesis with allograft. The procedure was carried out through a posterior approach. A posterior tuberosity osteotomy was need to visualize the subtalar joint. Progressive distraction was achieved and the calcaneus height was corrected. The subtalar joint was fixed with two screws. After 6 weeks, the patient started weight bearing and at 6-month follow-up arthrodesis consolidation was observed in CT. The ankle movement improved significantly. Subtalar distraction arthrodesis by inserting a structural bone graft is a reliable option to improve calcaneus height and restore talus calcaneus axes. Limited ankle dorsiflexion improves once talus orientation is corrected by this procedure.