Ankle Impingement & Synovitis
Introduction
This is Patient Education Article –Ankle Impingement. It explains the basics of the pathology including signs, symptoms and basic treatment options.
Ankle impingement occurs when soft tissues around the ankle are pinched or irritated. Impingement mainly happens when the ankle is fully bent up or down, leading to pain either in the front or back of the ankle joint. Problems near the front of the joint are usually associated with past ankle sprains. Problems in the back of the ankle occur usually due to irritation around a bony prominence and can involve certain tendons.
Causes
Pinching of tissues in the front of the ankle is called anterior impingement. Athletes who have had several mild sprains or one severe sprain are most likely to have anterior impingement. This is especially true for those who repeatedly bend the ankle upward (dorsiflexion), such as baseball catchers, basketball and football players and dancers.
Overtime, irritation along the front edge of the ankle can lead to impingement. Irritation can lead to thickening of the joint lining between the tibia and talus as the foot is dorsiflexed. In addition, bone spurs can form in this area, often making the pain worse.
A similar problem can happen after an ankle sprain. As the torn or ruptured ligament heals, the body responds by forming too much scar tissue along the front side of the ankle joint. This creates a small mass of tissue called a meniscoid lesion. Bending the ankle down can trap the tissue between the edge of the ankle joint, causing pain, popping and a feeling that the ankle will give out and not support your body weight.
Posterior impingement occurs in the back of the ankle and is common in ballet dancers or others who must continually rise up on their toes, pointing their foot downward into extreme plantarflexion. Bony prominences in the back of the ankle can pinch between the back of the leg bone and the heel bone. This creates inflammation, pain and swelling of the bone and soft tissues. Occasionally, the tendons that pass by the back of the ankle can become inflamed or even develop partial tears form the rubbing of the bony prominence.
Non-Surgical Treatment
You may be asked to rest the ankle for a short time to reduce swelling and pain. A special walking boot or short leg cast may be recommended to restrict ankle movement for up to 4 weeks. Sometimes Dr. DeMill may recommend a steroid injection into the painful area. Steroid injections are strong anti-inflammatory medications and can help relieve irritation and swelling in the soft tissues that are being pinched, reducing their tendency of getting pinched. You may also be asked to work with a physical therapist to help you regain normal use of your ankle. Patients often progress in a series of exercises including stationary cycling, range of motion and ankle strengthening.
Surgical Treatment
If nonsurgical treatments do not work, surgery may be recommended. The type of surgery will vary depending on the location and cause of your ankle impingement. Often, ankle impingement can be successfully treated with ankle arthroscopy or a scope procedure to clean out the joint. This procedure is done through very small incisions and typically have a quicker recovery time. However, sometimes an open procedure is required to remove the bone or soft tissue causing the impingement.
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