Common Diagnoses:
Ankle Impingement

Overview

Ankle impingement is a condition that causes a painful limitation of ankle range of motion due to a soft-tissue or bony abnormality. Soft-tissue impingement results from irritation to the fibers that go around a joint (capsule), or the joint’s ligaments or cartilage, which may thicken over time.

Symptoms

Ankle pain with specific motions (pointing the toe down in posterior impingement, bending the ankle up in anterior impingement)
Limited ankle range of motion
Ankle swelling

Diagnosis

A physical exam will be performed looking for abnormalities of the ankle. To confirm the diagnosis in some cases, a physician may consider an injection with numbing medication followed by repeating the test to see if the pain went away.

Imaging begins with ankle x-rays, although in some cases no abnormalities are seen. In posterior impingement, x-rays can identify the os trigonum or an elongated process of the calcaneus (heel bone). Ultrasound can be done to visualize thickening of the synovium (joint lining). Magnetic resonance imaging (MRI) can show bone marrow edema (swelling), abnormal soft tissue, or fibrous bands, but may be more helpful in ruling out other conditions in chronic ankle pain, such as tendonitis).

Treatment

Treatment begins with rest, ice, and anti-inflammation medications (for example, ibuprofen or naproxen). Exercises are important in order to strengthen the ankle muscles and tendons, as well as restore ankle stability. In persistent cases of ankle impingement, a steroid injection can be considered to further address the inflammation. Surgery may be indicated if all non-surgical measures fail. The choice of procedure depends on the type, severity, and nature of impingement.