Diagnostic Assessment — Right Ankle - Instability, Plantar Perifasciitis and Talonavicular Ganglion Cyst
Example 1 of 1 · fictitious patient (Veteran L)
Diagnostic Assessment
Right Ankle - Instability, Plantar Perifasciitis and Talonavicular Ganglion Cyst
Balance of Probabilities SOP: Joint Instability SOP No. 58 of 2019 - Factors (1), (3), (19); Ganglion SOP No. 8 of 2025 - Factor (1) Reasonable Hypothesis SOP: Joint Instability SOP No. 57 of 2019 - Factors (1), (3), (25); Ganglion SOP No. 7 of 2025 - Factor (1)
ADF History
The veteran, Date of Birth: [withheld] Electronic Warfare Operator, enlistment date 09 Feb 1990, discharge date 17 February 2000.
Occupational History
As an Electronic Warfare Operator in the Australian Army, the veteran was exposed to high-risk activities including parachute training and jumps, often conducted in challenging conditions including nighttime operations. The role required carrying heavy equipment over uneven terrain, prolonged walking, and operations in austere environments. Parachute training formed a critical component of his military duties, involving significant risk of injury during landing, particularly in low-light conditions with heavy equipment loads.
History
The veteran an Electronic Warfare Operator, sustained a significant right ankle inversion injury during a nighttime parachute jump in 1996, resulting in chronic ankle instability, plantar perifasciitis, and the development of a talonavicular ganglion cyst.
Timeline
13 September 1991: The veteran sustained a right ankle injury during a nighttime parachute jump, resulting in a right ankle sprain per the Strain SOP. He experienced immediate pain and instability, particularly during weight-bearing activities following the inversion mechanism injury upon landing. The injury was attributed to the hazardous nature of nighttime parachute operations with heavy equipment loads typical of his military role. No immediate imaging was conducted at the time, with treatment focused on rest and basic rehabilitation protocols. The condition caused ongoing discomfort during subsequent training activities and marked the beginning of chronic ankle problems. The injury represented a significant occupational hazard inherent to his military duties as an Electronic Warfare Operator requiring parachute qualification.
01 Apr 1998: X-rays with stress views showed no structural instability or bone lesions, but the veteran continued to report persistent right ankle instability with functional limitations. Pain and fatigue were specifically noted during prolonged walking activities, with the ankle feeling subjectively unstable or "floppy" during physical tasks. The examination was conducted to assess ongoing symptoms from the 1996 parachute injury, demonstrating persistent functional impairment despite normal structural imaging. No subluxation was visible on stress radiographs, indicating that the instability was primarily related to soft tissue damage rather than bony pathology. Physiotherapy was likely continued to address the chronic instability symptoms. The condition remained a significant functional limitation affecting his operational capabilities.
24 September 2018: An MRI confirmed multiple pathologies including a sprain of the deep fibers of the deltoid ligament, plantar perifasciitis, and a 12 mm talonavicular ganglion cyst. The veteran reported ongoing pain and instability, particularly during physical activities, consistent with his chronic ankle problems. Edema was noted in the plantar heel fat pad, with intact medial and lateral plantar fascia bands indicating chronic inflammatory changes. The ganglion cyst arose from the dorsal talonavicular joint, representing a secondary complication of chronic joint dysfunction. The findings were directly linked to the 1996 parachute injury and subsequent chronic overuse patterns from his military service. The condition continued to impact his mobility and quality of life in the post-service period.
Symptoms
At the time of the 1996 injury, the veteran experienced immediate pain and instability in the right ankle following the parachute landing, with difficulty weight-bearing and subjective feelings of ankle instability. Following the injury, symptoms persisted with ongoing pain during prolonged walking, fatigue in the ankle joint, and episodes where the ankle felt "floppy" or unstable. Current symptoms include persistent right ankle pain and instability particularly during physical activities, with confirmed ligament sprain, plantar perifasciitis causing heel pain, and a ganglion cyst contributing to ongoing discomfort and functional limitation that affects daily activities and quality of life.
Imaging
01 Apr 1998: X-rays with stress views showed no instability or bone lesions but persistent functional symptoms continued. No structural abnormalities were identified on stress radiographs.
24 September 2018: MRI findings revealed a sprain of the deep fibers of the deltoid ligament, plantar perifasciitis with edema in the plantar heel fat pad, and a 12 mm talonavicular ganglion cyst arising from the dorsal talonavicular joint. The medial and lateral plantar fascia bands remained intact despite the inflammatory changes. The findings were directly linked to the 1996 parachute injury and chronic overuse from military service.
1. What is the formal diagnosis of the condition claimed above?
Right Ankle - Instability (M24.272), Plantar Perifasciitis (M72.2), and Talonavicular Ganglion Cyst (M67.40), DVA SOP Joint Instability SOP No. 58 of 2019 and Ganglion SOP No. 8 of 2025, ICD-10 codes M24.272, M72.2, and M67.40.
Joint instability of the ankle is an acquired lack of stability due to damage to or abnormality of the stabilizing structures, manifesting as recurrent subluxation, recurrent dislocation, or recurrent sprain. This typically results from ligamentous injury that fails to heal properly, leading to chronic functional instability.
Plantar perifasciitis is inflammation of the tissues surrounding the plantar fascia, involving the fat pad and supporting structures of the heel. This condition typically develops secondary to chronic mechanical stress and can cause significant heel pain and functional limitation.
A ganglion cyst is a benign, cystic lesion overlying a joint or tendon, consisting of a thin fibrous capsule with no epithelial lining enclosing clear mucinous fluid. These commonly develop secondary to joint dysfunction or repetitive stress.
The temporal relationship shows the initial ankle sprain in 1996, persistent instability symptoms through 2002, with progression to chronic complications including perifasciitis and ganglion cyst formation confirmed in 2023.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? 13 September 1991 - during nighttime parachute jump.
When did the veteran first present to a health/medical provider for this condition? 13 September 1991 - the veteran first presented to a medical provider, likely a Military Medic or General Practitioner, immediately following the parachute jump injury.
When was the condition confirmed/formally diagnosed? 13 September 1991 - The ankle sprain was diagnosed at the time of injury. 24 September 2018 - The ankle instability, plantar perifasciitis, and talonavicular ganglion cyst were formally diagnosed by the treating doctor, Radiologist, at I-MED Radiology through MRI imaging.
When did the veteran first present to you (or your practice) for this condition? 25 November 2017
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions?
The diagnosis of right ankle instability was initially confirmed by clinical assessment in 1996 following the parachute jump injury, based on the mechanism of injury and immediate symptoms of pain and instability during weight-bearing. X-rays with stress views in 2002 showed no structural abnormalities but persistent functional symptoms continued.
The diagnoses of ankle instability, plantar perifasciitis, and talonavicular ganglion cyst were confirmed by MRI on 24 September 2018, reported by the treating doctor at I-MED Radiology. The MRI identified a sprain of the deep fibers of the deltoid ligament, edema in the plantar heel fat pad consistent with perifasciitis, and a 12 mm ganglion cyst arising from the dorsal talonavicular joint. The findings were consistent with chronic ankle dysfunction stemming from the 1996 parachute injury and ongoing occupational demands.
4. What do you consider to be the cause(s) of the condition in this veteran?
Having physical trauma to the affected joint at the time of the clinical onset of joint instability - MET
- The veteran experienced significant physical trauma to his right ankle during the 1996 nighttime parachute jump, causing immediate injury and subsequent chronic instability.
Having a sprain of the affected joint before the clinical onset of joint instability - MET
- The initial 1996 ankle sprain from the parachute jump directly led to the development of chronic joint instability due to inadequate healing of the ligamentous structures.
Inability to obtain appropriate clinical management for joint instability - MET
- There is evidence of inadequate clinical management as demonstrated by the 27-year delay between initial injury and comprehensive MRI investigation, and the progression from simple sprain to complex pathology including ganglion cyst formation, representing failure to provide appropriate ongoing clinical management per Brew v Repatriation Commission.
Inability to obtain appropriate clinical management for ganglion before clinical worsening - MET
- The ganglion cyst developed as a secondary complication without appropriate management of the underlying ankle pathology, representing inability to obtain appropriate clinical management that could have prevented this complication.
Sequelae
The plantar perifasciitis and talonavicular ganglion cyst are direct sequelae of the original 1996 right ankle sprain, developing due to chronic ankle dysfunction, altered biomechanics, and ongoing mechanical stress that resulted from inadequate management of the original service-related injury.
Unintended Consequence
This condition is not an unintended consequence of medical management as no specific medical procedures or medications directly caused the condition.
Inability to Attain Appropriate Medical Management
There was a clear inability to attain appropriate medical management as evidenced by the 27-year delay between initial injury in 1996 and comprehensive MRI investigation in 2023. The Full Federal Court in Brew v Repatriation Commission establishes that inability encompasses the lack of ability to get treatment in both objective and subjective senses. The extensive delay between initial presentation and definitive investigation, combined with the progression from simple sprain to complex pathology including ganglion cyst formation, constitutes evidence of barriers to healthcare satisfying the inability to attain appropriate medical management factor. This resulted in permanent worsening as the acute sprain progressed to chronic instability and secondary complications that could have been prevented with appropriate early intervention and ongoing specialized management.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication/prescribing history.
- See attached report
