Ankle Impingement Syndrome Treatment & Management

  • Author: Marc A Molis, MD, FAAFP; Chief Editor: Craig C Young, MD   more...
 
Updated: Jul 15, 2011
 

Acute Phase

Physical Therapy

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

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]

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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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.

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Contributor Information and Disclosures
Author

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

Marc A Molis, MD, FAAFP 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.

Specialty Editor Board

David T Bernhardt, MD  Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD  Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, 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, Director of Primary Care Sports Medicine Fellowship, 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, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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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Radiograph of an os trigonum in a ballet dancer. Image courtesy of Dr. Craig Young.
 
 
 
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