Learning objectives
Learning Objectives:
To review the anatomy and pathogenesis of ankle impingement syndromes.
To discuss the likely clinical presentation for each variant of impingement around the ankle.
To describe the merits of different imaging techniques and the relavent imaging appearances.
To summerise the basic management principles.
Key Learning Points:
Impinement is a clinical syndrome of chronic pain and restricted range of movement caused by compression of abnormal bone or soft tissue within the ankle joint.
Common sites of impingement within the ankle include posterior,
posteromedial,
anteromedial,...
Background
Who? Most commongly occurs in the active population following a sprain or repetitive micro-trauma at the extreme ranges of movement.
What? Chronic pain,
instability and limited range of movement.
How? Haemorrhage,
reactive synovial hyperplasia and scarring leading to abnormal soft tissue interposition within the joint.
Developmental or aquired bony spurs may also impede the normal range of movement.
Classification?This heterogenous group of pathologies is categorised according to the anatomical relation to the tibiotalar joint.
3 main types1...
Anterior impingement,
which can be subdivided into anterolateral,...
Imaging findings OR Procedure Details
Anterior impingement syndrome
Anterior ankle impingement is a well established and relatively common cause of chronic ankle pain,
particularly in soccer players,
runners and ballet dancers,
who sustain repetitive ankle dorsiflexion.
Symptoms are generally progressive and relate to impingement of hypertrophied synovial scar tissue and bony spurs within the anterior ankle joint.
Anatomy and pathophysiology
Ankle instability or repetitive forceful dorsiflexion can result in microtrauma to the anterior joint cartilage and deeper bone layers.
Over time,
attempted repair including fibrosis and fibrocartilage proliferation leads to...
Conclusion
Ankle impingement syndromes are an established cause of persistent ankle pain in young and athletic populations,
particularly presenting during rehabilitation after a sprain injury.
MRI is used to help support the clinical diagnosis,
to evaluate the rest of the joint for associated injury and to plan treatment.
Although we have described the different syndromes as distinct entities,
they often co-exist and commonly occur together with other pathologies.
MRI features of impingement may be found in asymptomatic patients and the diagnosis therefore requires careful clinical correlation....
References
Pesquer L,
Guillo S,
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US in ankle impingement syndrome.
J Ultrasound 2014;17:89-97.
Hopper MA,
Robinson P.
Ankle impingement syndromes.
Radiol Clin North Am 2008;46:6.
Amendola N,
Newhoff D,
Vaseenon T,
et al.
CAM-type impingement in the ankle.
Iowa Orthop J 2012;32:1-8.
Cerezal L,
Abascal F,
Canga A et al.
MR imaging of ankle impingement syndromes.
AJR Am J Roentgenol 2003;181(2):551–9.
McMurray TP.
Footballer’s ankle.
J Bone Joint Surg Br 1950;32B:68-9.
Morris LH.
Athlete’s ankle.
J Bone Joint Surg 1943;25:220.
Hayeri MR,
Trudell DJ,...
Personal Information
Edward Sellon,
Musculoskeletal Centre X-Ray Department,
Chapel Allerton Hospital,
Leeds,
UK LS7 4SA.
E-mail address:
[email protected]
Philip Robinson,
Musculoskeletal Centre X-Ray Department,
Chapel Allerton Hospital,
Leeds,
UK LS7 4SA.
E-mail address:
[email protected]