Ankle Impingement: Difference between revisions

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== Medical Management <br> ==
== Medical Management <br> ==


Diagnosis: <ref>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.</ref>  
Diagnosis: <ref name="Mura 2010">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.</ref>


1. Standard&nbsp;radiographs  
1. Standard&nbsp;radiographs  
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3. Diagnostic injection is a local anesthetic administered into joint capsule and soft tissue, if injection relieved the symptoms it is a postive test.  
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.<ref>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;amp; Ankle International [serial online]. May 2010;31(5):398-403. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 9, 2011.</ref>  
Surgery is considered after conservative treatment as been tried first,at least 3 months.<ref name="Say 2010" />  


El-Sayed et al states that arthroscopy&nbsp;is a useful method to treat patients with anterolateral impingement, results at follow-up showed 85% improved completely according to JSSF&nbsp;. <ref name="El-Sayed 2010">El-Sayed A. Arthroscopic treatment of anterolateral impingement of the ankle. Journal of Foot &amp;amp; Ankle Surgery [serial online]. May 2010;49(3):219-223. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 2, 2011.</ref>  
El-Sayed et al states that arthroscopy&nbsp;is a useful method to treat patients with anterolateral impingement, results at follow-up showed 85% improved completely according to JSSF&nbsp;. <ref name="Say 2010">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.</ref>


Chirugie et al showed VAS and AOFAS score improved significantly and 79% of patients returned to prior level of sport.<ref>Galla M, Lobenhoffer P. Technique and results of arthroscopic treatment of posterior ankle impingement. Foot &amp;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.</ref>  
Chirugie et al showed VAS and AOFAS score improved significantly and 79% of patients returned to prior level of sport. <ref name="Galla 2011">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.</ref>


Murawski et al showed 93% satisfaction, AOFAS and SF 36v2 significantly improved ~ 68%.<ref>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.</ref>  
Murawski et al showed 93% satisfaction, AOFAS and SF 36v2 significantly improved ~ 68%. <ref name="Mura 2010" />


Debridment, osteophyte removal, partial capsulectomy, and flexor hallux longus release, chondroplasty of tibia&nbsp;may be performed.<ref name="Galla, 2011">Galla M, Lobenhoffer P. Technique and results of arthroscopic treatment of posterior ankle impingement. Foot &amp;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.</ref><ref>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.</ref>  
Debridment, osteophyte removal, partial capsulectomy, and flexor hallux longus release, chondroplasty of tibia&nbsp;may be performed.<ref name="Mei 1993">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.</ref>  


<strike></strike><strike></strike>Complications include infection&nbsp;<ref>Galla M, Lobenhoffer P. Technique and results of arthroscopic treatment of posterior ankle impingement. Foot &amp;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.</ref>&nbsp;, neuropraxia, arthrofibrosis, complex regional pain syndrome. <ref>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.</ref>
<strike></strike><strike></strike>Complications include infection&nbsp;<ref name="Galla 2011" />&nbsp;, neuropraxia, arthrofibrosis, complex regional pain syndrome. <ref name="Mura 2010" />


== Physical Therapy Management <br>  ==
== Physical Therapy Management <br>  ==

Revision as of 17:33, 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!!

Search Strategy[edit | edit source]

Databases searched: PubMed, Cinahl


Search Terms: ankle impingement, ankle impingement syndrome


add text here related to databases searched, keywords, and search timeline

Definition/Description[edit | edit source]

Ankle impingement is defined as pain in the ankle (either anterior or posterior) due to impingement in one of three areas: anterolateral, anteromedial, and posteromedial. Pain is caused by mechanical obstruction due to osteophytes and entrapment of various soft tissue structures. The condition is common in athletes, especially soccer players, distance, runners and ballet dancers.  

Epidemiology/Etiology
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Anteromedial Impingement: Hypothesized etiology includes inversion ankle sprains, repetitive dorsiflexion resulting in spurs, repetitive capsular traction causing the formation of osteophytes, and chronic microtrauma to the anterior joint area. However, the cause remains unknown with the above theories mentioned in the literature. 


Anterolateral Impingement: May be caused by inversion ankle sprains causing inflammation and scar formation or reactive synovitis. 


Posterior Impingement: aka: "dancer's heel" May be caused by bony or soft tissue impingement, specifically flexor hallucis longus irritation, thickening of the posterior capsule, synovitis, inversion trauma/sprain, forced plantarflexion causing anterior sheering of the tibia, hypertrophy of the os trigonum impacting the posterior tibia. 

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 or chronic ankle instability 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.

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.

Physicians use radiographs as a means of medical diagnosis, but any radiographic findings must be correlated to patient symptoms. 

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 . [2]

Chirugie et al showed VAS and AOFAS score improved significantly and 79% of patients returned to prior level of sport. [3]

Murawski et al showed 93% satisfaction, AOFAS and SF 36v2 significantly improved ~ 68%. [1]

Debridment, osteophyte removal, partial capsulectomy, and flexor hallux longus release, chondroplasty of tibia may be performed.[4]

Complications include infection [3] , neuropraxia, arthrofibrosis, complex regional pain syndrome. [1]

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. 1.0 1.1 1.2 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.
  2. 2.0 2.1 El-Sayed A. Arthroscopic treatment of anterolateral impingement of the ankle. Journal of Foot & Ankle Surgery [serial online]. May 2010;49(3):219-223. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 2, 2011.
  3. 3.0 3.1 Galla M, Lobenhoffer P. Technique and results of arthroscopic treatment of posterior ankle impingement. Foot & 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.
  4. 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.