Background
Ankle impingement is defined as a painful mechanical limitation of full ankle range of motion secondary to an osseous or soft-tissue abnormality.[1, 2, 3, 4, 5, 6]
Soft-tissue impingement lesions of the ankle usually occur as a result of synovial or capsular irritation secondary to traumatic injuries, infection, or rheumatologic or degenerative disease states. Ankle impingement syndromes may also be congenital in origin. The leading causes of impingement lesions are posttraumatic injuries, usually ankle sprains, leading to chronic pain. Involved areas may include the anterolateral gutter, syndesmosis, and posterior ankle regions.
In 1950, Glassman et al reported on 9 patients who presented with chronic persistent pain and swelling around the anterolateral aspect of the ankle following an inversion ankle sprain.[7] At the time of surgery, a massive hyalinized connective-tissue band that extended from the anteroinferior region of the talofibular ligament (TFL) into the ankle joint was found. The authors referred to this pathologic entity as a meniscoid lesion because of its resemblance to a torn meniscus of the knee.[7] It was believed that repetitive tension on this tissue led to increasing hypertrophy and fibrosis, resulting in impingement on the talar cartilage and causing pain and swelling. Resolution of symptoms occurred in all cases with excision of the pathologic tissue.
In 1982, Waller described a pain syndrome along the anteroinferior border of the fibula and anterolateral talus following repetitive inversion injuries.[8] Examination of his patients revealed foot pronation and heel valgus. Waller believed this pathology to be synovial compression or chondromalacia of the lateral talar dome and called it the anterolateral corner compression syndrome.
Bassett et al found and described a separate pathologic fascicle of the anterior TFL (ATFL) in syndesmotic impingement.[9] Following a tear of the ATFL, the anterolateral talar dome extrudes anteriorly with dorsiflexion, resulting in impingement.
Hamilton described a labrum or pseudomeniscus of the posterior lip of the tibia, which can become torn or hypertrophied with ankle sprains and lead to posterior impingement.[10]
For excellent patient education resources, visit eMedicine's Foot, Ankle, Knee, and Hip Center, Sports Injury Center, and Sprains and Strains Center. Also, see eMedicine's patient education articles Ankle Sprain and Sprains and Strains.
Epidemiology
Frequency
United States
After an ankle sprain, 20-40% of patients have chronic ankle pain; of these patients, approximately one third has pain that is related to impingement.
Sport-Specific Biomechanics
The most common mechanism of an acute ankle impingement injury is plantar flexion/inversion injury that results in acute ankle sprain (eg, basketball player landing on opponent's shoe, cross-country runner stepping in a hole).
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