• Tae-Ha Lim, Hyung Rae Cho, Keum Nae Kang, Chang Joon Rhyu, Sung Won Chon, Young Su Lim, Jee In Yoo, Jung-Won Kim, and Young Uk Kim.
• Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul Department of Anesthesiology and Pain Medicine, Myongji Hospital, College of Medicine, Seonam University, Goyang Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul Department of Anesthesiology and Pain Medicine, Institute for Integrative medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea.
• Medicine (Baltimore). 2016 Dec 1; 95 (51): e5346.

RationaleAnkle syndesmotic injuries occasionally require long-term therapy for recovery and can result in tendon injury. Posterior tibial tendon dysfunction (PTTD) is an acquired deformity that can cause flatfoot deformity. The current nonoperative management of PTTD includes nonsteroidal antiinflammatory drugs (NSAIDs), orthopedic devices. Although various treatment options have been attempted, optimal treatments for each stage of the condition are debated. Polydeoxyribonucleotide (PDRN) is effective in healing of chronic wounds associated with tissue damage by attracting tissue growth factors.Patient ConcernsA 67-year-old woman who presented at our pain clinic with pain on the inside of ankle. She had a syndesmotic screw fixation 3 years prior. Her ankle pain had persisted after the removal of screws and edema for about 1 month resulting from long-term NSAIDs administration.DiagnosesThe origin of the pain was possibly tibialis posterior muscle and posterior tibial tendon and she was diagnosed as PTTD after syndesmosis surgery.InterventionsSono guided prolotherapy with PDRN was carried out.OutcomesPatient showed improvement in the arch of the foot, experienced pain relief, and was able to wear regular shoes without any orthopedic device.LessonsThis case report highlights that PDRN prolotherapy is a safe and efficient therapeutic option for the treatment of PTTD.

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