Foot and Ankle Surgery

Ankle Impingement Disease

ankle impingement disease

Ankle impingement disease is characterized  with pain and limitation of ankle joint during plantar or dorsal flexion.

Why ankle impingements occurs?

Impingement disorders are classified in  two main groups as anterior ankle impingement and posterior ankle impingement.

Anterior impingement  causes limitation in dorsiflexion motion and pain in the front part of the ankle. It is  frequently seen among basketball players, football players, and dancers.  Recurrent ankle sprains may cause thickening of the ligaments.This increase in volume may limit ankle dorsiflexion and irritate contact points of distal tibia and talus. It also cause pain in sudden forced dorsiflexion. Bony protrusions  on the  anterior distal tibial lip and over the talus develop in time. This limits the ankle dorsiflexion more.

ankle impingement disease

Posterior ankle impingement disease called on the back of the ankle impingement commonly seen in athletes like the ballerina and ballet that makes downward movement of the ankle (plantar flexion) commonly.However, at the back of the ankle, an accessory bone called os trigonum may be present or distal talar beak could be more prominent and big enough to cause irritation in extreme plantar flexion. Repetitive trauma causes irritation and pain in the posterior part of the ankle.

What kind of findings can be seen in ankle impingement disease?

In impingement disease, pain is increased in dorsiflexion action. Pain is felt in the anterior part. Sudden forced dorsiflexion produce pain. Distal tibial and dorsal talar bearing can be palpable in some patients.

Posterior ankle impingement (impingement) causes pain in the back of the ankle. The pain  is more pronounced with  activity, especially while climbing down the stairs. In these patients, pain is felt in the back of the ankle with deep palpation.  Sudden forced plantar flexion may cause extreme pain.

How can be  ankle impingement diagnosed?

In ankle impingement disease, diagnosis is made by physical examination. Impingement due to bone protrusions or os trigonum can be confirmed by radiographic examination. Orthopedist may want MRI study to rule out the other pathologies.

How is Ankle impingement treated ?

The treatment of ankle impingement disease is anti-inflammatory drug therapy and rest in the beginning. Foot ankle orthoses restricting the movements of the ankle and provides  pain reduce. Despite of these treatments, if the symptoms are persistent, arthroscopic surgery would be next choice.

What to do for ankle impingement disease in arthroscopic surgery?

Any soft or bony  tissue causing the impingement of the ankle, it can be removed by arthroscopic surgery. Synovitis, bony bumps, talar/tibia beaking  or accessory trigonum bone may cause anterior or  posterior impingement.  Arthroscopic surgery used successfully in the treatment of all.

About the author

Prof.Dr. Seref Aktas