eMedicine Specialties > Sports Medicine > Foot and Ankle

Ankle Impingement Syndrome: Differential Diagnoses & Workup

Author: Marc A Molis, MD, Medical Director of Sports Medicine, Sports Medicine of Iowa
Contributor Information and Disclosures

Updated: Aug 12, 2008

Differential Diagnoses

Other Problems to Be Considered

Calcific ossicles

Degenerative joint disease

Nerve entrapment (tarsal tunnel syndrome)

Occult fractures of the talus and calcaneus

Osteochondral lesions of the talus

Peroneal subluxation

Reflex sympathetic dystrophy (complex regional pain syndrome)

Subtalar joint dysfunction

Tarsal coalition

Workup

Imaging Studies

  • Plain radiography, bone scanning, and computed tomography (CT) scanning findings are usually normal. Plain radiographs may show an enlarged posterior tubercle of the talus or an os trigonum in patients with posterior ankle impingement.11,13  Having the patient adopt a lunge position that reproduces their pain may show bone-on-bone impingement on a plain radiograph. Patients with anterior ankle impingement may show tibial and talar spurring.
  • Magnetic resonance imaging (MRI) is the imaging technique of choice because of its advantage in identifying osseous and soft-tissue abnormalities. 
  • Stress radiography findings are usually negative, and this study is not indicated.
  • Ultrasound may be useful in identifying some synovitic lesions, especially within the anterolateral gutter.14

Related Medscape topic:
Specialty Site Radiology

More on Ankle Impingement Syndrome

Overview: Ankle Impingement Syndrome
Differential Diagnoses & Workup: Ankle Impingement Syndrome
Treatment & Medication: Ankle Impingement Syndrome
Follow-up: Ankle Impingement Syndrome
Multimedia: Ankle Impingement Syndrome
References
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References

  1. Ferkel RD. Soft tissue pathology of the ankle. In: McGinty JB, Caspari RB, Jackson RW, Poehling GG, eds. Operative Arthroscopy. 2nd ed. Philadelphia, Pa: Lippincott Raven; 1996:1141-55.

  2. Ferkel RD. Ankle and foot injuries. In: Fu FH, Stone DA, eds. Sports Injuries. Baltimore, Md: Lippincott Williams & Wilkins; 1994.

  3. Umans HR, Cerezal L. Anterior ankle impingement syndromes. Semin Musculoskelet Radiol. Jun 2008;12(2):146-53. [Medline].

  4. Sanders TG, Rathur SK. Impingement syndromes of the ankle. Magn Reson Imaging Clin N Am. Feb 2008;16(1):29-38, v. [Medline].

  5. Robinson P. Impingement syndromes of the ankle. Eur Radiol. Dec 2007;17(12):3056-65. [Medline].

  6. Pfeffer GB, ed. Chronic Ankle Pain in the Athlete (monograph). Rosemont, Ill: American Academy of Orthopaedic Surgeons; Dec 2000. AAOS Monograph Series. No. 17.

  7. Wolin I, Glassman F, Sideman S, Levinthal DH. Internal derangement of the talofibular component of the ankle. Surg Gynecol Obstet. Aug 1950;91(2):193-200. [Medline].

  8. Waller JF. Hindfoot and midfoot problems. Symposium on the foot and leg. In: Mack RP, ed. Running Sports. St. Louis, Mo: Mosby; 1982:pp 64-71.

  9. Bassett FH 3rd, Gates HS 3rd, Billys JB, Morris HB, Nikolaou PK. Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain. J Bone Joint Surg Am. Jan 1990;72(1):55-9. [Medline]. [Full Text].

  10. Hamilton WG. Tendonitis about the ankle joint in classical ballet dancers. Am J Sports Med. Mar-Apr 1977;5(2):84-8. [Medline].

  11. Maquirriain J. Posterior ankle impingement syndrome. J Am Acad Orthop Surg. Oct 2005;13(6):365-71. [Medline].

  12. Alfredson H, Cook J, eds. Pain in the Achilles region. In: Brukner P, Khan K. Clinical Sports Medicine. 2nd ed. New York: McGraw-Hill; 2000.

  13. Lee JC, Calder JD, Healy JC. Posterior impingement syndromes of the ankle. Semin Musculoskelet Radiol. Jun 2008;12(2):154-69. [Medline].

  14. McCarthy CL, Wilson DJ, Coltman TP. Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging. Skeletal Radiol. Mar 2008;37(3):209-16. [Medline].

  15. Henderson I, La Valette D. Ankle impingement: combined anterior and posterior impingement syndrome of the ankle. Foot Ankle Int. Sep 2004;25(9):632-8. [Medline].

  16. Ferkel RD. Arthroscopy of the foot and ankle. In: Coughlin MJ, Mann RA, eds. Surgery of the Foot and Ankle. 7th ed. St Louis, Mo: Mosby; 1999:1257-97.

  17. Ogilvie-Harris DJ, Gilbart MK, Chorney K. Chronic pain following ankle sprains in athletes: the role of arthroscopic surgery. Arthroscopy. Oct 1997;13(5):564-74. [Medline].

  18. Liu SH, Raskin A, Osti L, et al. Arthroscopic treatment of anterolateral ankle impingement. Arthroscopy. Apr 1994;10(2):215-8. [Medline].

  19. Ferkel RD, Karzel RP, Del Pizzo W, Friedman MJ, Fischer SP. Arthroscopic treatment of anterolateral impingement of the ankle. Am J Sports Med. Sep-Oct 1991;19(5):440-6. [Medline].

  20. Jackson DW, Ashley RL, Powell JW. Ankle sprains in young athletes. Relation of severity and disability. Clin Orthop Relat Res. Jun 1974;101:201-15. [Medline].

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Further Reading

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Keywords

ankle impingement syndrome, impingement lesions, Haglund's syndrome, Haglund syndrome, ankle injury, inversion ankle sprain, chronic ankle sprain, chronic ankle pain, sports injuries, anterior talofibular ligament, ATFL, anterolateral ankle impingement, syndesmosis impingement, posterior impingement, pseudomeniscus,  posterior ankle impingement, PAI, posteromedial ankle impingement, PoMI, os trigonum, meniscoid lesion, synovial irritation, capsular irritation, arthroscopic excision, arthroscopic debridement, anterolateral corner compression syndrome

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Contributor Information and Disclosures

Author

Marc A Molis, MD, Medical Director of Sports Medicine, Sports Medicine of Iowa
Marc A Molis, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Association, American Medical Society for Sports Medicine, and Iowa Medical Society
Disclosure: Nothing to disclose.

Medical Editor

David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin
David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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