ABOUT
Ankle impingement is defined as pain in the ankle due to impingement in one of two areas: anterior(in front) and posterior(backside). Historically, it has been called "athlete's ankle" and "footballer's ankle"
Ankle impingement generally refers to entrapment(squeezing) of structures/ tissue along the front or the back of the ankle joint in terminal movements. Pain is caused by mechanical obstruction due to osteophytes and/or entrapment of various soft tissue structures due to inflammation, scarring or hypermobility.
This condition is common in athletes, especially soccer players, distance runners and ballet dancers. Noted in athletes whose sports necessitated sudden acceleration, jumping, and extremes of joint movements.
SYMPTOMS AND INVESTIGATIONS
The typical symptoms include following like pain and tenderness over the anterior ankle joint, pain on dorsiflexion and plantar flexion, band of pain across anterior ankle when kicking a ball and palpable bony lump over the ankle joint. Anterior ankle pain is accompanied by a 'blocking sensation' in dorsiflexion. May also present with palpable soft tissue swelling over the anterior joint. As it becomes chronic, additional symptoms may include instability; limited ankle motion; and pain with squatting, sprinting, stair climbing, and hill-climbing. Normal walking is unaffected.
The investigations for this condition includes a weight-bearing x-ray of the affected ankle. The X-ray can also be done in a specific position in which the ankle is symptomatic, typically termed as stress x-ray. A CT scan or an MRI is often required to see for soft tissue as well as cartilage continuity inside the joint. These investigations are helpful in planning treatment.
TREATMENT
Initially, almost all patients are put on non-operative treatment. This includes stretching and strengthening exercises of surrounding muscles and ligaments. Also, some form of splints is required to give rest to the parts which are inflamed.
Sometimes a steroid injection can be given using fluoroscopy to the parts which are painful. This often gives great relief by decreasing the inflammation of the affected site.
Operative treatment is usually by a specialised procedure termed arthroscopy, just like a laparoscopy using keyhole incisions and specialised instruments the joint is directly visualised.
In arthroscopy using specialised instruments, the part of bones that is impinging is removed or reshaved to make it normal. This procedure also allows seeing whether the parts will re impinge or not.
The front, as well as back of the ankle, are examined using arthroscopy. Concomitant injuries like that of cartilage or other soft tissues and ligaments can be identified using this specialised procedure.