| In ankle impingement there is a limitation in the | | | | the tibia. MRI scanning (magnetic resonance |
| joint mobility of the ankle due to pain from a soft | | | | imaging) is more helpful to show bony or soft |
| tissue or bony pathology. A common finding to | | | | tissue problems. |
| precipitate this pain syndrome is an irritation of | | | | Conservative management is the mainstay of |
| the synovial membrane or the joint capsule, | | | | treatment for this condition and patients can |
| typically after an ankle sprain or a repetitive series | | | | reduce their symptoms if they modify the |
| of such injuries. Chronic pain in the ankle and | | | | activity levels they are performing or alter their |
| impingement can result from the ankle being | | | | techniques and methods. Non-steroidal |
| sprained and this can give a persistent pain | | | | anti-inflammatory drugs can be prescribed to |
| problem with limitations on involvement in sports. | | | | counter the pain and inflammatory changes. |
| Numbers are unclear but some level of | | | | Referral to physiotherapy is common to attempt |
| impingement could occur in about ten percent of | | | | joint mobilisation methods on the foot and ankle, |
| people who undergo ankle sprains. | | | | apply ultrasound, give deep friction massage and |
| Impingement is often secondary to an acute | | | | work on muscle power and joint motion. An ankle |
| ankle sprain where the person stands on | | | | brace can be fitted to support the joint laterally |
| something uneven or puts their foot into a hole in | | | | or to restrict the range of motion and |
| the ground, forcing the foot over into a | | | | physiotherapists can also assess and fit orthotics |
| downwards and inwards movement with the | | | | in the shoes. |
| weight of the body. Anterior impingement occurs | | | | Conservative treatment methods may not settle |
| at the front of the ankle and posterior | | | | impingement pain and then consideration turns |
| impingement behind, with another lesion type | | | | towards surgical intervention. Modern operation is |
| involving the connecting joint between the fibula | | | | usually performed arthroscopically, any loose |
| and the tibia just above the ankle joint proper. An | | | | tissue cut away, and bony spurs or soft tissue |
| anterior blocking feeling is often reported by | | | | abnormalities removed. Patients can rapidly |
| patients with this impingement as they try and | | | | mobilise after surgery and almost normal walking |
| get the foot up in the ankle. Moving the ankle into | | | | can start a few hours after operation provided |
| dorsiflexion with weight on it can bring on the pain. | | | | minor work has been performed. Patients may |
| If the syndesmosis (the connecting joint between | | | | need to wait 4 to 6 weeks before fully resuming |
| the fibula and tibia) has been injured and is causing | | | | their normal routines, in some cases guided by |
| symptoms, then palpating the local area may be | | | | physiotherapists. Results from trials of surgery for |
| extremely tender and pain elicited on compressing | | | | this condition have shown that eighty percent |
| the malleoli together. It is more difficult to | | | | have good to excellent outcomes. |
| diagnose posterior impingement as the symptoms | | | | In cases of more extensive surgery the patient |
| are often not so obvious although a forced | | | | may have to walk with crutches to limit the |
| downward movement of the foot may be painful. | | | | weight taken by the ankle and wear an ankle |
| Repeated lunging movements such as in ballet and | | | | brace to limit movement, moving up to bearing |
| fencing and kicking a ball in football can bring on | | | | full weight over a couple of weeks. At this point |
| anterior impingement as the front of the joint | | | | the physiotherapist may remove the brace and |
| suffers repeated microscopic damage which | | | | initiate range of movement exercises to restore |
| results in bony spur formation. | | | | normal movement to the foot and ankle. |
| Ankle impingement is difficult to investigate with | | | | Ultrasound and ice can also be used to control |
| the usual imaging methods as little may be | | | | inflammation and pain. With the ankle improving |
| apparent. Normal x-rays, bone scanning and | | | | the physiotherapist will move the patient on to |
| computed tomography (CT) scanning often show | | | | exercises without weight such as static bicycling in |
| little abnormal, although people with a diagnosis of | | | | the gym, and then to exercises on their feet to |
| anterior impingement may show spurs of bone on | | | | work on strength, balance, coordination and joint |
| the front surfaces of the ankle bone (talus) and | | | | position sense. |