Ankle Impingement: Difference between revisions
No edit summary |
No edit summary |
||
| Line 88: | Line 88: | ||
== Physical Therapy Management <br> == | == Physical Therapy Management <br> == | ||
Treatment will focus on increasing available joint space for more mobility and less pain. | |||
<u>Anterior Impingement:</u> | |||
Distraction manipulation | |||
A/P and lateral talocrural glides | |||
A/P distal fibula glides | |||
Cuboid whip (for those with decreased pronation) | |||
HEP: self A/P and lat mobilization, single leg balance, lunge dorsiflexion stretch, progressive ankle resistance exercises | |||
<u>Posterior Impingement:</u> | |||
Plantarflexion mobilization | |||
P/A talocrural mobilization | |||
Rearfoot distraction manipulation | |||
Proprioceptive work (wobble board, etc.) | |||
Fibularis strengthening (if weak) | |||
HEP: Achilles tendon stretching, Single leg balance, lunge dorsiflexion stretch, progressive ankle resistance exercises | |||
(NEED CITATION FOR THE REGIS PRESENTATION) | |||
== Key Research == | == Key Research == | ||
Revision as of 01:12, 16 July 2011
Original Editors Heather Hughes
Lead Editors - Heather Hughes, Angela Dempski, Christine Utskot, Alicia Shugart, Thomas Albaugh
Search Strategy[edit | edit source]
Databases searched: PubMed, Cinahl
Search Terms: ankle impingement, ankle impingement syndrome, ankle impingement surgery, ankle arthroscopy, os trigonum
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.[1] Historically, it has been called "athlete's ankle" and "footballer's ankle". [2]
Epidemiology/Etiology
[edit | edit source]
Anterior Impingement: aka: "athlete's ankle"
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]
add text here
Outcome Measures[edit | edit source]
The Foot Function Index (FFI) is viewed as a instrument tool to measure function in patients with rheumatoid arthritis, however, the authors claim there is no specific disease relation to rheumatoid arthritis in this assessment. The FFI was originally created for region specific pathologies in the older population. The FFI consists of 23 items grouped into 3 subscales, including activity limitation, disability, and pain subscales. A lower FFI score represents a higher level of function. (Evidence regarding score interpretation includes content validity, construct validity, reliability, and responsiveness.)
The Foot Health Status Questionnaire (FHSQ) developed to measure health-related quality of life with respect to foot health. This questionnaire takes 5 minutes to complete and consists of 4 subscales, including pain, function, footwear, general foot health. This questionnaire can be used by researcher and clinicians to identify changes in foot health status in response to therapeutic and surgical interventions. (Evidence for content validity, construct validity, and reliability is available.)
The Sports Ankle Rating System QOL is a self-reported and clinician completed assessment tool with 3 outcome measures that include a QOL measure, clinical rating score, and single numeric evaluation. The QOL measure, used to assess an athlete’s QOL after an ankle injury, contains 5 subscales that include symptoms, work and school activities, recreation and sports activities, activities of daily living, and lifestyle. (The QOL measure has evidence for content validity, construct validity, reli¬ability, and responsiveness.)
Examination[edit | edit source]
Anterior ankle impingement Examination: [3]
5 or more present: Sen= .94 Spec=.75 +LR=3.76 -LR=.08
-pain with activities
-anterolateral ankle joint tenderness
-recurrent joint swelling
-anterolateral pain with forced dorsiflexion and eversion (Impingement sign: Sens=.95 Spec=.88 +LR=7.91 -LR=.06) [4]
-pain during single leg squat
-lack of lateral ankle instability
MRI sensitivity = 39% Physical Examination sensitivity = 94% [3]
Posterior Ankle Impingement Examination: [5]
- Loss of mobility, accompanied by pain in posterior aspect of ankle
-pain with forced plantarflexion
-Prominent posterior talar processes
-Hyperplantar flexion test [6]
Medical Management
[edit | edit source]
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 positive 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. [7]
Murawski et al showed 93% satisfaction, AOFAS and SF 36v2 significantly improved ~ 68%. [1]
Debridement, osteophyte removal, meniscoid lesion excision, partial capsulectomy, and flexor hallux longus release, chondroplasty of tibia may be performed.[8] [9]
Complications include infection, neuropraxia, arthrofibrosis, complex regional pain syndrome, and peroneal nerve irritation. [1][7][9]
Medical Protocol: NWB in boot ~3 days, WBAT day 3, elevation for swelling, NSAIDs, ankle pumps, suture removal 10-14 days post-op, and refer to physical therapy. [10]
Physical Therapy Management
[edit | edit source]
Treatment will focus on increasing available joint space for more mobility and less pain.
Anterior Impingement:
Distraction manipulation
A/P and lateral talocrural glides
A/P distal fibula glides
Cuboid whip (for those with decreased pronation)
HEP: self A/P and lat mobilization, single leg balance, lunge dorsiflexion stretch, progressive ankle resistance exercises
Posterior Impingement:
Plantarflexion mobilization
P/A talocrural mobilization
Rearfoot distraction manipulation
Proprioceptive work (wobble board, etc.)
Fibularis strengthening (if weak)
HEP: Achilles tendon stretching, Single leg balance, lunge dorsiflexion stretch, progressive ankle resistance exercises
(NEED CITATION FOR THE REGIS PRESENTATION)
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 1.2 1.3 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.
- ↑ 2.0 2.1 2.2 El-Sayed A. Arthroscopic treatment of anterolateral impingement of the ankle. Journal of Foot &amp;amp;amp;amp;amp;amp;amp;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.
- ↑ 3.0 3.1 Liu S, Nuccion S, Finerman G. Diagnosis of anterolateral ankle impingement: comparison between magnetic resonance imaging and clinical examination. American Journal of Sports Medicine [serial online]. May 1997;25(3):389-393. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 15, 2011.
- ↑ Molloy S, Solan M, Bendall S. Synovial impingement in the ankle: a new physical sign. Journal of Bone & Joint Surgery, British Volume [serial online]. April 2003;85B(3):330-333. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 15, 2011
- ↑ Albisetti W, Ometti M, Pascale V, De Bartolomeo O. Clinical evaluation and treatment of posterior impingement in dancers. American Journal of Physical Medicine & Rehabilitation [serial online]. May 2009;88(5):349-354. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 15, 2011.
- ↑ Dijk van, C. Niek. Anterior and Posterior Ankle Impingement. Foot Ankle Clinica N Am 11 (2006) 663-683
- ↑ 7.0 7.1 Galla M, Lobenhoffer P. Technique and results of arthroscopic treatment of posterior ankle impingement. Foot &amp;amp;amp;amp;amp;amp;amp;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.
- ↑ 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.
- ↑ 9.0 9.1 Hussan A. Treatment of anterolateral impingements of the ankle joint by arthroscopy. Knee Surg Sports Traumatol Arthrosec. 2007; 15:150-1154. Accessed July 15,2011.
- ↑ Coetzee J, Ebeling P. Arthroscopic Ankle Debridement Rehabilitation Protocol Website. Available at: http://www.tcomn.com/images/wmimages/onlineforms/Arthroscopic_Ankle_Debridement.pdf. Accessed July 15, 2011.
