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Ankle Impingement Syndrome Treatment & Management

  • Author: Marc A Molis, MD, FAAFP; Chief Editor: Craig C Young, MD  more...
Updated: Sep 30, 2015

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, 20, 21]

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.


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.

Contributor Information and Disclosures

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, Iowa Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, 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, American Medical Society for Sports Medicine

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, 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

Disclosure: Nothing to disclose.

Additional Contributors

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, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

  1. Ferkel RD. Soft tissue pathology of the ankle. 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. 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. 2008 Jun. 12(2):146-53. [Medline].

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

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

  6. Pfeffer GB, ed. Chronic Ankle Pain in the Athlete (monograph). Dec 2000.

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

  8. Waller JF. Hindfoot and midfoot problems. Symposium on the foot and leg. 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. 1990 Jan. 72(1):55-9. [Medline]. [Full Text].

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

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

  12. Alfredson H, Cook J, eds. Pain in the Achilles region. 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. 2008 Jun. 12(2):154-69. [Medline].

  14. McCarthy CL, Wilson DJ, Coltman TP. Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging. Skeletal Radiol. 2008 Mar. 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. 2004 Sep. 25(9):632-8. [Medline].

  16. Ferkel RD. Arthroscopy of the foot and ankle. 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. 1997 Oct. 13(5):564-74. [Medline].

  18. Liu SH, Raskin A, Osti L, et al. Arthroscopic treatment of anterolateral ankle impingement. Arthroscopy. 1994 Apr. 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. 1991 Sep-Oct. 19(5):440-6. [Medline].

  20. Wiegerinck JI, Vroemen JC, van Dongen TH, Sierevelt IN, Maas M, van Dijk CN. The posterior impingement view: an alternative conventional projection to detect bony posterior ankle impingement. Arthroscopy. 2014 Oct. 30 (10):1311-6. [Medline].

  21. Smyth NA, Zwiers R, Wiegerinck JI, Hannon CP, Murawski CD, van Dijk CN, et al. Posterior hindfoot arthroscopy: a review. Am J Sports Med. 2014 Jan. 42 (1):225-34. [Medline].

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

  23. Vilá J, Vega J, Mellado M, Ramazzini R, Golanó P. Hindfoot endoscopy for the treatment of posterior ankle impingement syndrome: a safe and reproducible technique. Foot Ankle Surg. 2014 Sep. 20 (3):174-9. [Medline].

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