Physiotherapy Management of Kager’s Fat Pad Irritation Associated with a Multi-ligament Ankle Sprain and Tendinopathy in a 35-YearOld Male Patient: A Case Report

Kager’s fat pad irritation is an under-recognised source of posterior ankle pain, especially when occurring alongside multiligament ankle sprains and tendinopathy. This case report describes the rehabilitation of a 35-year-old male who presented with chronic right ankle pain and instability, attributed to long-term barefoot walking for religious purposes and repeated, untreated ankle sprains. Magnetic Resonance Imaging (MRI) revealed irritation of the Kager’s fat pad, sprains of the Anterior Talofibular Ligament (ATFL), Calcaneofibular Ligament (CFL), Posterior Talofibular Ligament (PTFL), and tenosynovitis of the posterior tibialis and flexor digitorum longus tendons. The patient underwent a physiotherapy programme focused on pain relief, proprioceptive retraining, strengthening, and functional restoration. Over the course of rehabilitation, the patient demonstrated marked improvements in pain, stability, and balance, with the Numeric Pain Rating Scale (NPRS) decreasing from 6 to 0, Balance Error Scoring System (BESS) errors reducing from 21 to 8, and the Foot and Ankle Ability Measure – Activities of Daily Living (FAAM-ADL) score improving from 61% to 92%. This case emphasises the effectiveness of conservative physiotherapy in complex ankle pathologies and the need to consider cultural factors like habitual barefoot walking in clinical decision-making.