Diagnosis: Anterior Ankle Impingement
Presentation:
Anterior ankle impingement is a condition which often presents after a major ankle injury. It is characterised by pain and stiffness in the front of the ankle. People with anterior ankle impingement may also feel as if their ankle is unstable. Impingement reduces the range of motion of the ankle joint, so activities that require the ankle to move through a large range will cause the most discomfort, examples are: Stair climbing, walking up hills and squatting (Vogrin & Kuhta, 2012).
Anterior ankle impingement is a condition which often presents after a major ankle injury. #performbetter @pogophysio Click To TweetDiagnosis:
Anterior ankle impingement is diagnosed using the patient’s history, a physical examination and often an X-ray or MRI. Key things that the therapist is looking for in the history is a previous (not necessarily recent) severe injury or fracture of the ankle or any patient activities that may have caused repetitive strain on the bones of the front of the ankle. In the physical exam the ankle will have a reduced range of motion compared to the un-injured ankle. The therapist may use a knee to wall test to measure the extent of the motion loss. Finally, radiography is used to diagnose this condition, however radiography is most useful to determine what kind of treatment will be best (Vogrin & Kuhta, 2012).
Causes:
The most common cause of anterior ankle impingement is osteophyte formation at the front of the ankle. Osteophytes, commonly called “bone spurs” are bony projections that grow about cartilage due to trauma. These bone spurs block and hinder normal movement. The impingement can also be caused by soft tissue structures blocking the movement or a tight capsule hindering the ankle motion.
Treatment:
Conservative treatment is best in patients with a milder impingement. Initial treatment will involve massage and electrotherapy to reduce swelling, pain and apprehension to the movement of the ankle. The physiotherapist will then apply manual therapy techniques aiming to glide the surfaces of the ankle joint into restriction and loosen up the structures. Home manual therapy and a stretching regime is provided to the patient. After the initial stages of treatment, when the ankle has loosened up, strengthening and balance exercises are performed and manual therapy will continue. In cases where the impingement is not relieved after conservative management, surgery may help. Surgery of an ankle impingement involves an arthroscope to remove the osteophytes or other structures that are blocking the ankle, physiotherapy is commenced post-surgery (Talusan, Toy, Perez, Milewski, & Reach, 2014).
Daniel O’Connor
Student Physiotherapist
References
Talusan, P., Toy, J., Perez, J., Milewski, M., & Reach, J. (2014). Anterior Ankle Impingement. Journal Of The American Academy Of Orthopaedic Surgeons, 22(5), 333-339.
Vogrin, M. & Kuhta, M. (2012). Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation (pp. 635-638). London: Springer.
