Ankle impingement syndromes

Ankle impingement syndromes

Ankle impingement syndromes are pathologic conditions which can result in chronic, painful restriction to movement at the tibiotalar articulation secondary to soft-tissue or osseous abnormalities.1 Ankle impingement, typically secondary to an ankle sprain, is classified according to its anatomic relationship to the tibiotalar joint as anterolateral2, anterior3, anteromedial4, posteromedial5, or posterior6 impingement. Cross-sectional imaging, ultrasound or MRI, is useful for assessing ankle impingement. MRI, in particular, is also valuable for identifying other causes of persistent ankle pain that may mimic or coexist with ankle impingement, such as occult fractures, cartilage damage, intra-articular bodies, osteochondral talar lesions, tendon abnormalities, and ankle instability.1
Literature
  1. Ogilvie-Harris DJ, Gilbart MK, Chorney K. Chronic pain following ankle sprains in athletes: the role of arthroscopic surgery. Arthroscopy 1997; 13:564-574
  2. Ferkel RD, Karzel RP, Del Pizzo W, Friedman MJ, Fischer SP. Arthroscopic treatment of anterolateral impingement of the ankle. Am J Sports Med 1991; 19:440-446
  3. van Dijk CN, Tol JL, Verheyen CC. A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement. Am J Sports Med 1997; 25:737-745
  4. Robinson P, White LM, Salonen D, Ogilvie-Harris D. Anteromedial impingement of the ankle: using MR arthrography to assess the anteromedial recess. AJR 2002; 178:601-604
  5. Paterson RS, Brown JN. The posteromedial impingement lesion of the ankle: a series of six cases. Am J Sports Med 2001; 29:550-557
  6. Hamilton WG, Geppert MJ, Thompson FM. Pain in the posterior aspect of the ankle in dancers: differential diagnosis and operative treatment. J Bone Joint Surg Am 1996; 78:1491-1500

 

Physical Examination

Forced Dorsiflexion Test1Alonso et al. assessed the reliability of manual stress tests for syndesmotic ankle sprains and the ability of these tests to predict return to function, and they found that only the external rotation stress test had good reliability and was predictive of the time that it took to return to function.

Five of the six symptoms are seen as a positive ankle impingement3
  1. Anterolateralanklesensitivity
    2. Anterolateral ankle swelling
    3. Pain at forced dorsiflexion
    4. Pain in single-leg squat on the affected leg
    5. Pain in activities
    6. Absence of ankle instability
Literature
  1. Alonso A, Khoury L, Adams R. Clinical tests for ankle syndesmosis injury: reliability and prediction of return to function. J Orthop Sports Phys Ther. 1998;27(4):276-284
  2. Liu SH, Nuccion SL, Finerman G. Diagnosis of anterolateral ankle impingement: comparison between magnetic resonace imaging and examination. Am J Sports Med. 1997;25(3):389-393

 

Evidence Based Practice

Forced Dorsiflexion Test  Utility 2
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Alsonso et al.1 NT NT NA
Molloy et al.2 95 88 8
Literature
  1. Alonso A, Khoury L, Adams R. Clinical tests for ankle syndesmosis injury: reliability and prediction of return to function. J Orthop Sports Phys Ther. 1998;27(4):276-284
  2. Molloy S, Solan MC, Bendall SP. Synovial impingement in the ankle: a new physical sign. J Bone Joint Surg Br. 2003;85(3):330-333
 Clinical Prediction Rule for ankle impingement Utility 2
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Liu et al.3 94 75 7
Literature
  1. Liu SH, Nuccion SL, Finerman G. Diagnosis of anterolateral ankle impingement: comparison between magnetic resonace imaging and examination. Am J Sports Med. 1997;25(3):389-393

 

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