Select Page
  • facebook
  • googleplus
  • linkedin

Orthopaedics 360

“A Place to Learn”

Ankle impingement is characterised by abnormal abutment of excessive soft tissue or bone, during normal ankle movement, resulting in pain. The pain is caused by a mechanical obstruction to movement. Ankle impingement is typically described based on the location of the ‘impingement’ and the underlying cause.

Anterior Impingement

Posterior Impingement

 

Anterior Ankle Impingement

Ankle anatomy adelaide orthopaedic surgeon mike smith ankle arthritis ankle arthroscopy treatment best image
  • facebook
  • googleplus
  • linkedin

 

Anterior ankle impingement is one of the most common ankle presentations seen by orthopaedic surgeons. ‘Anterior’ refers to the region at the front of the ankle joint. The ankle joint is made up of the lower end of the tibia (shin bone) and fibula, which both articulate with the talus bone.

In the normal ankle joint, there is an anterior recess or space, that allows the ankle to ‘dorsiflex’ without any mechanical obstruction. When there is excessive soft tissue scarring or bone formation (‘osteophytes’) in this space, the ankle is unable to move freely, and ‘impingement’ occurs with resultant pain and stiffness.

Bony Vs Soft Tissue Impingement

What is the difference?

Bony Impingement

ankle arthroscopy adelaide mike smith orthopaedic surgeon
  • facebook
  • googleplus
  • linkedin

 

Anterior Bony impingement is characterised by the formation of spur ‘osteophytes’ at the front of the lower tibia. This is a common condition in athletes with repetitive ankle dorsiflexion, such as football players, soccer players, ballet dancers, and runners. Repetitive micro trauma to the cartilage at the front of the tibia results in progressive scar cartilage (fibrocartilage) formation and ‘osteophytes’. These osteophytes can ‘break off’ and become loose bodies within the ankle joint.

Soft Tissue Impingement

Anterior soft tissue impingement is usually the result of recurrent ankle sprains (inversion injuries). Chronic inflammation and scarring of the synovial lining results in soft tissue entrapment within the front of the ankle joint.

  • facebook
  • googleplus
  • linkedin

 

Posterior Ankle Impingement

mike smith adelaide ankle surgeon os trigonum surgery ankle pain impingement ballet
  • facebook
  • googleplus
  • linkedin

 

Posterior Ankle Impingement refers to abnormal abutment of excessive soft tissue or bone at the ‘back’ of the ankle joint. This ‘abutment’ occurs when the ankle is positioned in a plantar flexed position (such as is seen in ballet dancers).

 

The posterior aspect of the ankle region is made up of the ‘back’ of the tibia (shin bone), the ‘back’ of the talus, and the back of the calcaneus (Heel bone). The tendon to the big toe (FHL tendon) runs through this region, and can be irritated with this condition.

Os Trigonum

The most common cause of Posterior Impingement

The most common cause of posterior impingement is the presence of an ‘Os Trigonum’. An ‘Os Trigonum’ is an un-united tubercle at the back of the talus. It is seen in up to 10% of the population, and often present in both ankles. Most patients with an Os Trigonum do not have any symptoms.

mike smith adelaide ankle surgeon os trigonum surgery ankle pain impingement best image
  • facebook
  • googleplus
  • linkedin

 

Following either an ankle sprain, or repetitive plantar flexion, such as that experienced in ballet dancers, the Os Trigonum can cause irritation and pain at the back of the ankle.

Steida Process

Another form of bony impingement is seen in patients with a Steida Process. This represents an elongated tubercle (posterolateral) of the talus. Despite not have the ‘un-united’ section that is seen in the Os Trigonum, the same abutment of tissue occurs at the back of the ankle, resulting in pain.

mike smith adelaide ankle surgeon os trigonum surgery ankle pain impingement steida process
  • facebook
  • googleplus
  • linkedin

 

KeyHole Surgery used to treat Impingement

Making the Diagnosis

Anterior Impingement

Patients typically present with pain at the front of the ankle joint, which is made worse with ankle ‘dorsiflexion’ movements. These include walking uphill, running, landing from a jump, and pushing the brake of a car. A history of recurrent ankle sprains is often present.

Typically a weight bearing xray and MRI scan are performed. Bone impingement is visualised on the plain xrays as anterior spurring on the lower end of the tibia. Soft tissue impingement requires a MRI scan for visualisation.

anterior ankle impingement mike smith orthopaedic surgeon adelaide
  • facebook
  • googleplus
  • linkedin

Posterior Impingement

Patients typically present with pain at the back of the ankle joint. This is exacerbated by repetitive plantar flexion activities. While this is classically described in Ballet dancers, whilst performing Pointe work, it can also be seen in many athletes during running and jumping activities. A plain xray will asses for the presence of an ‘Os Trigonum’ or ‘Steida Process’. A MRI scan confirms any associated soft tissue irritation and assess for high signal within the os trigonum.

mike smith adelaide ankle surgeon os trigonum surgery ankle pain impingement mri
  • facebook
  • googleplus
  • linkedin

 

 

Do you have pain at the end of ankle movement?

You may have ankle impingement which would benefit from keyhole surgery

Keyhole Arthroscopic Treatment for Ankle Impingement

In patients that have failed conservative measures, a keyhole arthroscopic ‘decompression’ is typically offered. This allows direct visualisation of both soft tissue and bony causes for impingement, and clearance of these structures can be performed. Both Anterior and Posterior ankle arthroscopies can be performed.

mike smith adelaide ankle surgeon os trigonum surgery ankle pain impingement keyhole arthroscopy
  • facebook
  • googleplus
  • linkedin

 

 

 

 

 

 

 

Do you have symptoms consistent with ankle impingement?

Pain at the end of ankle movement

Difficulty walking uphill | Running | Jumping

Previous ankle injuries

Disclaimer: Please note that this is general advice only - for more information, please consult your regular doctor, or obtain a referral to see a specialist orthopaedic surgeon. 

Orthopaedics 360

Orthopaedics 360

P: (08) 7099 0188

F: (08) 7099 0171

Southern Specialist Centre

Orthopaedics 360

P: (08) 7099 0188

F: (08) 7099 0171

Health @ Hindmarsh

Orthopaedics 360

P: (08) 7099 0188

F: (08) 7099 0171

  • facebook
  • googleplus
  • linkedin

"Tailored Surgical Excellence"

LATEST NEWS

Rugby Union SA partnership
  • facebook
  • googleplus
  • linkedin

Rugby Union SA partnership

Orthopaedics 360 are proud to be partnered with Rugby Union SA. With one of the most active sporting clubs in South Australia, we have acknowledged the growing need for customised care for the growing and established athletes.

CONTACT US

Orthopaedics 360

A: 94-96 Fullarton Road, Norwood 5067

P: (08) 7099 0188

F: (08) 7099 0171

Share This

Share This

Like it? We'd love you to share it!