eMedicine Specialties > Sports Medicine > Foot and Ankle

Ankle Impingement Syndrome

Marc A Molis, MD, Medical Director of Sports Medicine, Sports Medicine of Iowa

Updated: Aug 12, 2008

Introduction

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

Background

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.

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Ankle Sprain
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Recurrent Ankle Sprains

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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).

Clinical

History

Anterior ankle impingement: Chronic ankle pain occurs, usually presenting as persistent pain or disability after an ankle sprain.
Anterolateral ankle impingement: Chronic vague pain over the anterolateral ankle occurs, usually associated with cutting and pivoting movements.
Syndesmosis impingement: Syndesmotic or a "high" ankle sprain occurs in up to 10% of all ankle injuries.
Posterior impingement: This syndrome is usually located posteriorly or posterolaterally following an ankle sprain.

Physical

Anterior ankle impingement: Anterior ankle pain is present with a subjective feeling of stiffness or "blocking" on dorsiflexion. The pain is usually most severe with dorsiflexion, and dorsiflexion may be limited on examination. It is possible to do the anterior impingement test, in which the patient lunges forward maximally with the heel on the floor. If this test reproduces the pain, the test is positive and suggestive of anterior impingement. Swelling over the anterior aspect of the ankle may be present.
Anterolateral ankle impingement: Tenderness is noted along the lateral gutter and ATFL. Proprioception may be poor in these patients.
Syndesmosis impingement: Extreme tenderness along the syndesmosis and interosseous membrane is noted, along with pain on bimalleolar compression of the syndesmosis and on passive external rotation stress of the ankle.
Posterior impingement: The diagnosis of posterior ankle impingement is often difficult, requiring a high index of clinical suspicion. Posterior impingement often causes lingering pain, swelling, and catching of a synovial nodule, and it may be worse with forced plantar flexion. If further confirmation is necessary, local anesthetic can be injected around the posterior talus, and then the impingement test (reproduction of pain with passive plantarflexion of the ankle) can be performed without pain.

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Causes

Anterior ankle impingement: Seen in activites that cause forced dosiflexion. Seen in soccer players while kicking (sometimes termed "footballer's ankle") and ballet dancers (especially with pliés, which are lunging maneuvers). Chronic damage or microtrauma leads to subsequent bone spur formation (anterior tibiotalar spurs), which cause subsequent limitation of movement and pain.
Anterolateral ankle impingement: Common causes are inversion ankle injuries and sprains sustained while playing basketball (45%), volleyball (25%), or soccer (31%). Injury to the ligament or joint capsule may lead to synovitis, scar tissue, hypertrophied soft tissue, and, ultimately, impingement.
Syndesmosis impingement: Tearing of the syndesmosis or the ATFL results in chronic instability and extrusion of the anterolateral talus, leading to syndesmotic impingement. Ice hockey, football, and soccer players often sustain this type of injury.
Posterior impingement: Hypertrophy or tear of the posterior inferior TFL, transverse TFL, tibial slip, or pathologic labrum on the posterior ankle joint can lead to posterior ankle impingement, which may pinch on the os trigonum or posterior talus of calcaneus. This syndrome can also result from pathology of the os trigonum-talar process, ankle osteochondritis, flexor hallucis longus tenosynovitis, subtalar joint disease, and fracture. Pain is caused by forced plantar flexion and push-off maneuvers, as seen in dancing, kicking, gymnastics, or downhill-running types of activities.¹¹ In ballet dancers, forcing turnout of the foot can predispose to this condition.¹²

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Differential Diagnoses

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

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Treatment

Acute Phase

Rehabilitation Program

Physical Therapy

The initial treatment of ankle impingement syndrome includes nonsteroidal antiinflammatory drugs (NSAIDs) as needed for pain, physical therapy, bracing, and orthotics.

Related eMedicine topic:
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Surgical Intervention

With the failure of conservative modalities, surgical intervention is indicated. Arthroscopic excision and debridement is the treatment of choice.^{15,16,17,18,19}

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Other Treatment

Occasionally, steroid injection into the affected area may give relief. Intra-articular anesthetic (lidocaine) ankle injection can be used as a differential tool to distinguish between ankle pain and subtalar pain.

Electrotherapeutic modalities may also be helpful.

In ballet dancers, technique assessment is helpful and essential to prevent further pain and injury.

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Local Anesthetic Agents, Infiltrative Administration
Therapeutic Injections for Pain Management

Recovery Phase

Rehabilitation Program

Physical Therapy

Postoperatively, advise posterior splinting for 1 week, as well as a supportive brace and elastic compression stocking. Physical therapy is initiated at 2-3 weeks for strengthening, range of motion, proprioception, and sport-specific rehabilitation.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Nonsteroidal anti-inflammatory drugs

NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action of these agents is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well; these may include inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

Ibuprofen (Motrin, Ibuprin)

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Dosing

Adult

400-800 mg PO tid with food

Pediatric

10 mg/kg PO tid with food

Interactions

Coadministration with aspirin increases the risk of inducing serious NSAID-related adverse effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; may increase PT duration when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Contraindications

Documented hypersensitivity; peptic ulcer disease, recent GI bleeding or perforation; renal insufficiency; high risk of bleeding

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in patients with congestive heart failure, hypertension, and decreased renal and hepatic function; caution in the presence of coagulation abnormalities or during anticoagulant therapy

Ketoprofen (Actron, Orudis, Oruvail)

For the relief of mild to moderate pain and inflammation. Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease.

Doses >75 mg do not increase the therapeutic effects. Administer high doses with caution and closely observe the patient for response.

Dosing

Adult

25-50 mg PO q6-8h prn; not to exceed 300 mg/d

Pediatric

<3 months: Not established

3 months to 12 years: 0.1-1 mg/kg PO q6-8h

>12 years: Administer as in adults

Interactions

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in patients with congestive heart failure, hypertension, and decreased renal and hepatic function; caution in the presence of coagulation abnormalities or during anticoagulant therapy

Naproxen (Aleve, Naprosyn, Anaprox, Naprelan)

For the relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.

Dosing

Adult

500 mg PO followed by 250 mg q6-8h; not to exceed 1.25 g/d

Pediatric

<2 years: Not established

>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d

Interactions

Contraindications

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of the drug.

Sulindac (Clinoril)

Decreases the activity of cyclooxygenase which, in turn, inhibits prostaglandin synthesis. Results in a decreased formation of inflammatory mediators.

Dosing

Adult

150-200 mg PO bid or 300-400 PO qd; not to exceed 400 mg/d

Pediatric

Not established

Interactions

Coadministration with aspirin increases the risk of inducing serious NSAID-related adverse effects; probenecid may the increase concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; may increase PT duration when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Contraindications

Documented hypersensitivity; hypersensitivity to aspirin, iodides or other NSAIDs; GI bleeding; renal insufficiency

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases the risk of acute renal failure in preexisting renal disease or compromised renal perfusion; low white blood cell counts occur rarely, and usually return to normal in ongoing therapy; discontinuation of therapy may be necessary if there is persistent leukopenia, granulocytopenia, or thrombocytopenia; caution in the presence of anticoagulation defects or in patients who are receiving anticoagulant therapy

Flurbiprofen (Ansaid)

May inhibit the cyclooxygenase enzyme, which, in turn, inhibits prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.

Dosing

Adult

200-300 mg/d PO divided bid/qid

Pediatric

Not established

Interactions

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion, risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of the drug.

Opioid analgesics

Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who have sustained trauma or who have sustained injuries.

Acetaminophen and codeine (Tylenol #3)

May inhibit the cyclooxygenase enzyme, which, in turn, inhibits prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.

Dosing

Adult

30-60 mg/dose PO q4-6h (based on codeine content) or 1-2 tab PO q4h; not to exceed 4 g/d of acetaminophen

Pediatric

0.5-1 mg/kg/dose PO q4-6h (based on codeine content); 10-15 mg/kg/dose PO (based on acetaminophen content); not to exceed 2.6 g/d of acetaminophen

Interactions

The toxicity of codeine increases with CNS depressants, TCAs, MAOIs, neuromuscular blockers, phenothiazines, and opioid analgesics; rifampin can reduce the analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase the hepatotoxicity of acetaminophen.

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in patients who are dependent on opiates, because this substitution may result in acute opiate-withdrawal symptoms; caution in patients with severe renal or hepatic dysfunction; hepatotoxicity with acetaminophen is possible in persons with chronic alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; acetaminophen is contained in many OTC products, and combined use with these products may result in cumulative acetaminophen doses that exceed recommended the maximum dose.

Hydrocodone and acetaminophen (Vicodin, Norcet, Lortab)

Drug combination indicated for moderate to severe pain.

Dosing

Adult

1-2 tab or cap PO q4-6h prn

Pediatric

<12 years: 10-15 mg/kg/dose PO q4-6h (based on acetaminophen content) prn; not to exceed 2.6 g/d acetaminophen

>12 years: 750 mg PO q4h (based on acetaminophen content); not to exceed 10 mg hydrocodone bitartrate per dose or 5 doses/d

Interactions

Coadministration with phenothiazines may decrease analgesic effects; toxicity increases with CNS depressants or TCAs

Contraindications

Documented hypersensitivity; high-altitude cerebral edema or elevated intracranial pressure

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Tablets contain metabisulfite, which may cause hypersensitivity; caution in patients who are dependent on opiates because this substitution may result in acute opiate-withdrawal symptoms; caution in the presence of severe renal or hepatic dysfunction

Hydrocodone and ibuprofen (Vicoprofen)

Drug combination indicated for the short-term (<10 d) relief of moderate to severe acute pain.

Dosing

Adult

1-2 tab PO q4-6h prn; not to exceed 5 tab/d

Pediatric

Not established

Interactions

Coadministration with aspirin increases the risk of inducing serious NSAID-related adverse effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; monitor PT duration closely (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Contraindications

Documented hypersensitivity; third trimester of pregnancy

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in patients with impaired renal function, peptic ulcer disease, impaired thyroid function, asthma, hypertension, edema, heart failure, increased intracranial pressure, and erosive gastritis; the duration of action may increase in elderly persons

Propoxyphene and acetaminophen (Darvocet-N 100, Propacet, Wygesic)

Drug combination indicated for mild to moderate pain.

Dosing

Adult

1-2 tab PO q4h prn; not to exceed 600 mg/d

Pediatric

Not established

Interactions

May increase the serum concentrations of MAOIs, TCAs, carbamazepine, phenobarbital, and warfarin

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in patients who are dependent on opiates because this substitution may result in acute opiate withdrawal symptoms; caution in patients with severe renal or hepatic dysfunction

Follow-up

Return to Play

Patients with ankle impingement syndrome are allowed to return to sports or activities as tolerated in approximately 4-6 weeks, depending on the completion of physical therapy goals. Somewhat longer rehabilitation may be required with syndesmotic impingement.

Related Medscape topics:
Resource Center Exercise and Sports Medicine
Resource Center Joint Disorders

Prevention

In sports such as ballet, correct technique can help prevent injury.

Miscellaneous

Special Concerns

According to multiple follow-up studies, excellent and good postoperative results can be expected for approximately 84% of patients.^17,18,19

Related Medscape topic:
Resource Center Medical Malpractice and Legal Issues

Multimedia

Media file 1: Radiograph of an os trigonum in a ballet dancer. Image courtesy of Dr. Craig Young.

References

Ferkel RD. Soft tissue pathology of the ankle. In: McGinty JB, Caspari RB, Jackson RW, Poehling GG, eds. Operative Arthroscopy. 2^nd ed. Philadelphia, Pa: Lippincott Raven; 1996:1141-55.
Ferkel RD. Ankle and foot injuries. In: Fu FH, Stone DA, eds. Sports Injuries. Baltimore, Md: Lippincott Williams & Wilkins; 1994.
Umans HR, Cerezal L. Anterior ankle impingement syndromes. Semin Musculoskelet Radiol. Jun 2008;12(2):146-53. [Medline].
Sanders TG, Rathur SK. Impingement syndromes of the ankle. Magn Reson Imaging Clin N Am. Feb 2008;16(1):29-38, v. [Medline].
Robinson P. Impingement syndromes of the ankle. Eur Radiol. Dec 2007;17(12):3056-65. [Medline].
Pfeffer GB, ed. Chronic Ankle Pain in the Athlete (monograph). Rosemont, Ill: American Academy of Orthopaedic Surgeons; Dec 2000. AAOS Monograph Series. No. 17.
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].
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.
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].
Hamilton WG. Tendonitis about the ankle joint in classical ballet dancers. Am J Sports Med. Mar-Apr 1977;5(2):84-8. [Medline].
Maquirriain J. Posterior ankle impingement syndrome. J Am Acad Orthop Surg. Oct 2005;13(6):365-71. [Medline].
Alfredson H, Cook J, eds. Pain in the Achilles region. In: Brukner P, Khan K. Clinical Sports Medicine. 2^nd ed. New York: McGraw-Hill; 2000.
Lee JC, Calder JD, Healy JC. Posterior impingement syndromes of the ankle. Semin Musculoskelet Radiol. Jun 2008;12(2):154-69. [Medline].
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].
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].
Ferkel RD. Arthroscopy of the foot and ankle. In: Coughlin MJ, Mann RA, eds. Surgery of the Foot and Ankle. 7^th ed. St Louis, Mo: Mosby; 1999:1257-97.
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].
Liu SH, Raskin A, Osti L, et al. Arthroscopic treatment of anterolateral ankle impingement. Arthroscopy. Apr 1994;10(2):215-8. [Medline].
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].
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].

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

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.

Further Reading

eMedicine Specialties > Sports Medicine > Foot and Ankle

Ankle Impingement Syndrome

Introduction

Background

Frequency

United States

Sport-Specific Biomechanics

Clinical

History

Physical

Causes

Differential Diagnoses

Other Problems to Be Considered

Workup

Imaging Studies

Treatment

Acute Phase

Rehabilitation Program

Physical Therapy

Surgical Intervention

Other Treatment

Recovery Phase

Rehabilitation Program

Physical Therapy

Medication

Nonsteroidal anti-inflammatory drugs

Ibuprofen (Motrin, Ibuprin)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Ketoprofen (Actron, Orudis, Oruvail)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Naproxen (Aleve, Naprosyn, Anaprox, Naprelan)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Sulindac (Clinoril)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Flurbiprofen (Ansaid)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Opioid analgesics

Acetaminophen and codeine (Tylenol #3)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy