Ankle Impingement: Difference between revisions

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== Characteristics/Clinical Presentation  ==
== Characteristics/Clinical Presentation  ==


<u>'''Anterolateral'''</u>: Patients will experience anterolateral ankle pain that is intensified with supination or pronation of the foot, anterolateral point tenderness, pain with a single-leg squat, and swelling.  
<u>'''Anterolateral'''</u>: Patients experience anterolateral ankle pain that is intensified with supination or pronation of the foot, anterolateral point tenderness, pain with a single-leg squat, and swelling. Patients may have a history of ankles sprains and now present with constant lateral ankle pain upon ambulation.


<u>'''Anteromedial'''</u>:&nbsp;A good portion of these patients will have chronic anteromedial pain that is intensified by dorsiflexion, TTP focally over anteromedial ankle, soft tissue swelling, and decreased ROM into dorsiflexion as well as supination.  
<u>'''Anteromedial'''</u>:&nbsp;A good portion of these patients will have chronic anteromedial pain that is intensified by dorsiflexion, tender to palpation over anteromedial joint line, soft tissue swelling, and decreased ROM into forced dorsiflexion as well as supination.  


Anterior:  
Anterior:  

Revision as of 04:42, 11 July 2011

Welcome to Texas State University's Evidence-based Practice project space. This is a wiki created by and for the students in the Doctor of Physical Therapy program at Texas State University - San Marcos. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors Heather Hughes


Lead Editors - Heather Hughes, Angela Dempski, Christine Utskot, Alicia Shugart, Thomas Albaugh

Search Strategy[edit | edit source]

Databases searched: PubMed


Search Terms: ankle impingement, ankle impingement syndrome


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Definition/Description[edit | edit source]

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Epidemiology/Etiology[edit | edit source]

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Characteristics/Clinical Presentation[edit | edit source]

Anterolateral: Patients experience anterolateral ankle pain that is intensified with supination or pronation of the foot, anterolateral point tenderness, pain with a single-leg squat, and swelling. Patients may have a history of ankles sprains and now present with constant lateral ankle pain upon ambulation.

Anteromedial: A good portion of these patients will have chronic anteromedial pain that is intensified by dorsiflexion, tender to palpation over anteromedial joint line, soft tissue swelling, and decreased ROM into forced dorsiflexion as well as supination.

Anterior:

Posterior:

Posteromedial: A key clinical finding for a patient with a posteromedial impingement is tenderness to the posteromedial aspect upon inversion with the ankle in plantar flexion. This helps to differentiate from pain that comes from a tibialis posterior abnormality.

Differential Diagnosis[edit | edit source]

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Outcome Measures[edit | edit source]

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Examination[edit | edit source]

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Medical Management
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Diagnosis: [1]

1. Standard radiographs

2. MRI for soft tissue swelling and extent of injury

3. Diagnostic injection is a local anesthetic administered into joint capsule and soft tissue, if injection relieved the symptoms it is a postive test.

Surgery is considered after conservative treatment as been tried first,at least 3 months.[2]

El-Sayed et al states that arthroscopy is a useful method to treat patients with anterolateral impingement, results at follow-up showed 85% improved completely according to JSSF . [3]

Chirugie et al showed VAS and AOFAS score improved significantly and 79% of patients returned to prior level of sport.[4]

Murawski et al showed 93% satisfaction, AOFAS and SF 36v2 significantly improved ~ 68%.[5]

Debridment, osteophyte removal, partial capsulectomy, and flexor hallux longus release, chondroplasty of tibia may be performed.[6][7]

Complications include infection [8] , neuropraxia, arthrofibrosis, complex regional pain syndrome. [9]

Physical Therapy Management
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Key Research[edit | edit source]

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Resources
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Clinical Bottom Line[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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  1. ↑ Murawski C, Kennedy J. Anteromedial impingement in the ankle joint: outcomes following arthroscopy. American Journal of Sports Medicine [serial online]. October 2010;38(10):2017-2024. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 2, 2011.
  2. ↑ Noguchi H, Ishii Y, Takeda M, Hasegawa A, Monden S, Takagishi K. Arthroscopic excision of posterior ankle bony impingement for early return to the field: short-term results. Foot &amp; Ankle International [serial online]. May 2010;31(5):398-403. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 9, 2011.
  3. ↑ El-Sayed A. Arthroscopic treatment of anterolateral impingement of the ankle. Journal of Foot &amp; Ankle Surgery [serial online]. May 2010;49(3):219-223. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 2, 2011.
  4. ↑ Galla M, Lobenhoffer P. Technique and results of arthroscopic treatment of posterior ankle impingement. Foot &amp; Ankle Surgery (Elsevier Science) [serial online]. June 2011;17(2):79-84. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 2, 2011.
  5. ↑ Murawski C, Kennedy J. Anteromedial impingement in the ankle joint: outcomes following arthroscopy. American Journal of Sports Medicine [serial online]. October 2010;38(10):2017-2024. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 9, 2011.
  6. ↑ Galla M, Lobenhoffer P. Technique and results of arthroscopic treatment of posterior ankle impingement. Foot &amp; Ankle Surgery (Elsevier Science) [serial online]. June 2011;17(2):79-84. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 2, 2011.
  7. ↑ Meislin R, Rose D, Parisien J, Springer S. Arthroscopic treatment of synovial impingement of the ankle. American Journal of Sports Medicine [serial online]. March 1993;21(2):186-189. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 9, 2011.
  8. ↑ Galla M, Lobenhoffer P. Technique and results of arthroscopic treatment of posterior ankle impingement. Foot &amp; Ankle Surgery (Elsevier Science) [serial online]. June 2011;17(2):79-84. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 2, 2011.
  9. ↑ Murawski C, Kennedy J. Anteromedial impingement in the ankle joint: outcomes following arthroscopy. American Journal of Sports Medicine [serial online]. October 2010;38(10):2017-2024. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 2, 2011.
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