Skip to main content
SpringerLink
Log in

Evaluation of Ankle Impingement

  • Chapter
  • First Online:
The Art of the Musculoskeletal Physical Exam

  • 1483 Accesses

Abstract

Ankle impingement is a broad term that encompasses both anterior and posterior ankle joint abnormalities of both bony and soft-tissue pathologies. It could also occur with combinations of both anterior and posterior joint pathologies that present simultaneously. The exact etiology behind ankle impingement syndromes might not be well understood. Generally, causative theories range from repetitive microtrauma and repetitive impaction injury to degenerative joint diseases’ post-traumatic or malunion causes. Irrespective of the etiology, broadly the affected individual might complain of joint swelling, stiffness, pain, and eventual dysfunction. Impingement syndromes are readily appreciated by thorough history taking and adequate clinical examination. The different anatomical and pathological impingement syndromes can be diagnosed by various radiological investigations. In some instances, ultimately a local infiltrative diagnostic injection might be very useful to confirm the diagnosis, but in some cases, it might also help to alleviate the presenting symptoms, becoming an adequate therapeutic tool.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ogilvie-Harris DJ, Gilbart MK, Chorney K. Chronic pain following ankle sprains in athletes: the role of arthroscopic surgery. Arthroscopy. 1997;13(5):564–74.

    CAS  PubMed  Google Scholar 

  2. Biedert R. Anterior ankle pain in sports medicine: aetiology and indications for arthroscopy. Arch Orthop Trauma Surg. 1991;110(6):293–7.

    CAS  PubMed  Google Scholar 

  3. van den Bekerom MP, Raven EE. The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome: a current concepts review. Knee Surg Sports Traumatol Arthrosc. 2007;15(4):465–71.

    PubMed  PubMed Central  Google Scholar 

  4. Sanders TG, Rathur SK. Impingement syndromes of the ankle. Magn Reson Imaging Clin N Am. 2008;16(1):29–38.

    PubMed  Google Scholar 

  5. Dimmick S, Linklater J. Ankle impingement syndromes. Radiol Clin N Am. 2013;51(3):479–510.

    PubMed  Google Scholar 

  6. Bojanic I, Bergovec M, Smoljanovic T. Combined anterior and posterior arthroscopic portals for loose body removal and synovectomy for synovial chondromatosis. Foot Ankle Int. 2009;30(11):1120–3.

    PubMed  Google Scholar 

  7. Allegra F, Maffulli N. Double posteromedial portals for posterior ankle arthroscopy in supine position. Clin Orthop Relat Res. 2010;468(4):996–1001.

    PubMed  Google Scholar 

  8. Kim HK, Jeon JY, Dong Q, Kim HN, Park YW. Ankle arthroscopy in a hanging position combined with hindfoot endoscopy for the treatment of concurrent anterior and posterior impingement syndrome of the ankle. J Foot Ankle Surg. 2013;52(6):704–9.

    PubMed  Google Scholar 

  9. Abdelatif NMN. Combined arthroscopic management of concurrent posterior and anterior ankle pathologies. Knee Surg Sports Traumatol Arthrosc. 2014;22(11):2837–42.

    PubMed  Google Scholar 

  10. Lavery KP, Mchale KJ, Rossy WH, Theodore G. Ankle Impingement. J Orthop Surg Res. 2016;11:97. https://doi.org/10.1186/s13018-016-0430-x.

    Article  PubMed  PubMed Central  Google Scholar 

  11. O’Donoghue DH. Impingement exostoses of the talus and tibia. J Bone Joint Surg Am. 1957;39-A(4):835–52.

    PubMed  Google Scholar 

  12. Tol JL, van Dijk CN. Etiology of the anterior ankle impingement syndrome: a descriptive anatomical study. Foot Ankle Int. 2004;25(6):382–6.

    PubMed  Google Scholar 

  13. Hayeri MR, Trudell DJ, Resnick D. Anterior ankle impingement and Talar bony outgrowths: osteophyte or Enthesophyte? Paleopathologic and cadaveric study with imaging correlation. Am J Roentgenol. 2009;193(4):W334–8.

    Google Scholar 

  14. Berberian WS, Hecht PJ, Wapner KL, DiVerniero R. Morphology of tibiotalar osteophytes in anterior ankle impingement. Foot Ankle Int. 2001;22(4):313–7.

    CAS  PubMed  Google Scholar 

  15. Tol JL, Slim E, van Soest AJ, van Dijk CN. The relationship of the kicking action in soccer and anterior ankle impingement syndrome. A biomechanical analysis. Am J Sports Med. 2002;30(1):45–50.

    PubMed  Google Scholar 

  16. Massada JL. Ankle overuse injuries in soccer players. Morphological adaptation of the talus in the anterior impingement. J Sports Med Phys Fitness. 1991;31(3):447–51.

    CAS  PubMed  Google Scholar 

  17. Mouhsine E, Crevoisier X, Leyvraz PF, Akiki A, Dutoit M, Garofalo R. Post-traumatic overload or acute syndrome of the os trigonum: a possible cause of posterior ankle impingement. Knee Surg Sports Traumatol Arthrosc. 2004;12(3):250–3.

    CAS  PubMed  Google Scholar 

  18. Lui TH. Posterior ankle impingement syndrome caused by malunion of joint depressed type calcaneal fracture. Knee Surg Sports Traumatol Arthrosc. 2008;16(7):687–9.

    CAS  PubMed  Google Scholar 

  19. Nikolopoulos CE, Tsirikos AI, Sourmelis S, Papachristou G. The accessory anteroinferior tibiofibular ligament as a cause of talar impingement: a cadaveric study. Am J Sports Med. 2004;32(2):389–95.

    PubMed  Google Scholar 

  20. Golano P, Vega J, Perez-Carro L, Gotzens V. Ankle anatomy for the Arthroscopist. Part II: role of the ankle ligaments in soft tissue impingement. Foot Ankle Clin. 2006;11(2):275–96.

    PubMed  Google Scholar 

  21. LiMarzi GM, Khan O, Shah Y, Yablon CM. Imaging manifestations of ankle impingement syndromes. Radiol Clin N Am. 2018;56(6):893–916.

    PubMed  Google Scholar 

  22. Linklater J. MR imaging of ankle impingement lesions. Magn Reson Imaging Clin N Am. 2009;17(4):775–800.

    PubMed  Google Scholar 

  23. Robinson P, White LM, Salonen D, Ogilvie-Harris D. Anteromedial impingement of the ankle: using MR arthrography to assess the anteromedial recess. AJR Am J Roentgenol. 2002;178(3):601–4.

    CAS  PubMed  Google Scholar 

  24. Umans H, Cerezal L. Anterior Ankle Impingement Syndromes. Semin Musculoskelet Radiol. 2008;12(2):146–53.

    PubMed  Google Scholar 

  25. Robinson P, White LM. Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management. Radiographics. 2002;22(6):1457–69.

    PubMed  Google Scholar 

  26. de Vries JS, Krips R, Sierevelt IN, Blankevoort L, van Dijk CN. Interventions for treating chronic ankle instability. Cochrane Database Syst Rev. 2011;(8):CD004124.

    Google Scholar 

  27. Ross KA, Murawski CD, Smyth NA, Zwiers R, Wiegerinck JI, van Bergen CJA, Dijk CN, Kennedy JG. Current concepts review: arthroscopic treatment of anterior ankle impingement. Foot Ankle Surg. 2017;23(1):1–8.

    PubMed  Google Scholar 

  28. van Dijk CN, van Bergen CJA. Advancements in ankle arthroscopy. J Am Acad Orthop Surg. 2008;16(11):635–46.

    PubMed  Google Scholar 

  29. Dalmau-Pastor M, Malagelada F, Kerkhoffs GMMJ, Karlsson J, Manzanares MC, Vega J. The anterior tibiofibular ligament has a constant distal fascicle that contacts the anterolateral part of the talus. Knee Surg Sports Traumatol Arthrosc. 2020;28(1):48–54.

    PubMed  Google Scholar 

  30. Berman Z, Tafur M, Ahmed SS, Huang BK, Chang EY. Ankle impingement syndromes: an imaging review. Br J Radiol. 2017;90(1070):20160735.

    PubMed  PubMed Central  Google Scholar 

  31. Rosenbaum AJ, Positano RG, Positano RCJ, Dines JS. Ankle impingement caused by an intra-articular plica: a report of 2 cases. Foot Ankle Spec. 2016;9(1):79–82.

    PubMed  Google Scholar 

  32. Hermans JJ, Beumer A, de Jong TAW, Kleinrensink GJ. Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach. J Anat. 2010;217(6):633–45.

    PubMed  PubMed Central  Google Scholar 

  33. Taylor M, Amendola N. Chapter 2: impingement syndromes of the ankle. In: Porter D, Schon L, editors. Baxter’s the foot and ankle in sport. 3rd ed. Amsterdam: Elsevier; 2020. p. 8–21. ISBN: 9780323549424.

    Google Scholar 

  34. Mccarroll JR, Schrader JW, Shelbourne KD, Rettig AC, Bisesi MA. Meniscoid lesions of the ankle in soccer players. Am J Sports Med. 1987;15(3):255–7.

    CAS  PubMed  Google Scholar 

  35. Valderrabano V, Perren T, Ryf C, Rillmann P, Hintermann B. Snowboarder’s talus fracture: treatment outcome of 20 cases after 3.5 years. Am J Sports Med. 2005;33(6):871–80.

    PubMed  Google Scholar 

  36. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970;52(5):991–1002.

    CAS  PubMed  Google Scholar 

  37. Harburn TE, Ross HE. Avulsion fracture of the anterior calcaneal process. Phys Sportsmed. 1987;15(4):73–80.

    CAS  PubMed  Google Scholar 

  38. Sewell RB. A study of the astragalus. J Anat Physiol. 1904;38(Pt 3):233–47.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Martus JE, Femino JE, Caird MS, Kuhns LR, Craig CL, Farley FA. Accessory anterolateral talar facet as an etiology of painful talocalcaneal impingement in the rigid flatfoot: a new diagnosis. Iowa Orthop J. 2008;28:1–8.

    PubMed  PubMed Central  Google Scholar 

  40. Sammarco GJ, DiRaimondo CV. Chronic peroneus brevis tendon lesions. Foot Ankle. 1989;9(4):163–70.

    CAS  PubMed  Google Scholar 

  41. Thompson FM, Patterson AH. Rupture of the peroneus longus tendon. Report of three cases. J Bone Joint Surg Am. 1989;71(2):293–5.

    CAS  PubMed  Google Scholar 

  42. Fiorella D, Helms CA, Nunley JA 2nd. The MR imaging features of the posterior intermalleolar ligament in patients with posterior impingement syndrome of the ankle. Skelet Radiol. 1999;28(10):573–6.

    CAS  Google Scholar 

  43. Lohrer H, Arentz S. Posterior approach for arthroscopic treatment of posterolateral impingement syndrome of the ankle in a top-level field hockey player. Arthroscopy. 2004;20(4):e15–21.

    PubMed  Google Scholar 

  44. Rosenberg ZS, Cheung YY, Beltran J, Sheskier S, Leong M, Jahss M. Posterior intermalleolar ligament of the ankle: normal anatomy and MR imaging features. AJR Am J Roentgenol. 1995;165(2):387–90.

    CAS  PubMed  Google Scholar 

  45. Best A, Giza E, Linklater J, Sullivan M. Posterior impingement of the ankle caused by anomalous muscles. A report of four cases. J Bone Joint Surg Am. 2005;87(9):2075–9.

    PubMed  Google Scholar 

  46. Seipel R, Linklater J, Pitsis G, Sullivan M. The peroneocalcaneus internus muscle: an unusual cause of posterior ankle impingement. Foot Ankle Int. 2005;26(10):890–3.

    PubMed  Google Scholar 

  47. Koulouris G, Connell D, Schneider T, Edwards W. Posterior tibiotalar ligament injury resulting in posteromedial impingement. Foot Ankle Int. 2003;24(8):575–83.

    PubMed  Google Scholar 

  48. Paterson RS, Brown JN. The posteromedial impingement lesion of the ankle. A series of six cases. Am J Sports Med. 2001;29(5):550–7.

    CAS  PubMed  Google Scholar 

  49. Peace KA, Hillier JC, Hulme A, Healy JC. MRI features of posterior ankle impingement syndrome in ballet dancers: a review of 25 cases. Clin Radiol. 2004;59(11):1025–33.

    CAS  PubMed  Google Scholar 

  50. Diniz P, Sousa D, Batista J, Abdelatif N, Pereira H. Diagnosis and treatment of anterior ankle impingement: state of the art. J ISAKOS. 2020;5:295–303. https://doi.org/10.1136/jisakos-2019-000282.

    Article  Google Scholar 

  51. Moser BR. Posterior ankle impingement in the dancer. Curr Sports Med Rep. 2011;10(6):371–7.

    PubMed  Google Scholar 

  52. Hamilton WG, Geppert MJ, Thompson FM. Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment. J Bone Joint Surg Am. 1996;78(10):1491–500.

    CAS  PubMed  Google Scholar 

  53. Russell JA, Kruse DW, Koutedakis Y, McEwan IM, Wyon MA. Pathoanatomy of posterior ankle impingement in ballet dancers. Clin Anat. 2010;23(6):613–21.

    PubMed  Google Scholar 

  54. Russell JA, Kruse DW, Koutedakis Y, Wyon MA. Pathoanatomy of anterior ankle impingement in dancers. J Dance Med Sci. 2012;16(3):101–8.

    PubMed  Google Scholar 

  55. Ribbans WJ, Ribbans HA, Cruickshank JA, Wood EV. The management of posterior ankle impingement syndrome in sport: a review. Foot Ankle Surg. 2015;21(1):1–10.

    PubMed  Google Scholar 

  56. van Dijk CN. Anterior and posterior ankle impingement. Foot Ankle Clin. 2006;11:663–83.

    Google Scholar 

  57. Na JB, Bergman AG, Oloff LM, Beaulieu CF. The flexor hallucis longus: tenographic technique and correlation of imaging findings with surgery in 39 ankles. Radiology. 2005;236(3):974–82.

    PubMed  Google Scholar 

  58. Molloy S, Solan MC, Bendall SP. Synovial impingement in the ankle. A new physical sign. J Bone Joint Surg (Br). 2003;85(3):330–3.

    CAS  PubMed  Google Scholar 

  59. Liu SH, Nuccion SL, Finerman G. Diagnosis of anterolateral ankle impingement. Comparison between magnetic resonance imaging and clinical examination. Am J Sports Med. 1997;25(3):389–93.

    CAS  PubMed  Google Scholar 

  60. Scholten PE, Seirevelt IN, van Dijk CN. Hindfoot endoscopy for posterior ankle impingement. J Bone Joint Surg Am. 2008;90:2665–72.

    CAS  PubMed  Google Scholar 

  61. Hedrick MR, McBryde AM. Posterior ankle impingement. Foot Ankle Int. 1994;15:2–8.

    CAS  PubMed  Google Scholar 

  62. Takao M, Uchio Y, Naito K, Kono T, Oae K, Ochi M. Arthroscopic treatment for anterior impingement exostosis of the ankle: application of three-dimensional computed tomography. Foot Ankle Int. 2004;25(2):59–62.

    PubMed  Google Scholar 

  63. McCarthy CL, Wilson DJ, Coltman TP. Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging. Skelet Radiol. 2008;37(3):209–16.

    CAS  Google Scholar 

  64. Pesquer L, Guillo S, Meyer P, Hauer O. US in ankle impingement syndrome. J Ultrasound. 2014;17(2):89–97.

    PubMed  Google Scholar 

  65. Hauger O, Moinard M, Lasalarie JC, Chauveaux D, Diard F. Anterolateral compartment of the ankle in the lateral impingement syndrome: appearance on CT arthrography. AJR Am J Roentgenol. 1999;173(3):685–90.

    CAS  PubMed  Google Scholar 

  66. Farooki S, Yao L, Seeger LL. Anterolateral impingement of the ankle: effectiveness of MR imaging. Radiology. 1998;207(2):357–60.

    CAS  PubMed  Google Scholar 

  67. Rubin DA, Tishkoff NW, Britton CA, Conti SF, Towers JD. An-terolateral soft-tissue impingement in the ankle: diagnosis using MR imaging. AJR Am J Roentgenol. 1997;169(3):829–35.

    CAS  PubMed  Google Scholar 

  68. Duncan D, Mologne T, Hildebrand H, Stanley M, Schreckengaust R, Sitler D. The usefulness of magnetic resonance imaging in the diagnosis of anterolateral impingement of the ankle. J Foot Ankle Surg. 2006;45(5):304–7.

    PubMed  Google Scholar 

  69. Wiegerinck JI, Vroemen JC, van Dongen TH, Sierevelt IN, Maas M, van Dijk CN. The posterior impingement view: an alternative conventional projection to detect bony posterior ankle impingement. Arthroscopy. 2014;30(10):1311–6.

    PubMed  Google Scholar 

  70. Masciocchi C, Catalucci A, Barile A. Ankle impingement syndromes. Eur J Radiol. 1998;27(Suppl 1):S70–3.

    PubMed  Google Scholar 

  71. Donovan A, Rosenberg ZS. MRI of ankle and lateral hindfoot impingement syndromes. AJR Am J Roentgenol. 2010;195:595–604.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Foot and Ankle Reconstructive Surgery, DrNasef OrthoClinic, Private Practice, Cairo, Egypt

    Nasef M. N. Abdelatif

Authors
  1. Nasef M. N. Abdelatif
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Musculoskeletal and Joint Research Foundation, San Diego, CA, USA

    John G. Lane

  2. O.A.S.I. Bioresearch Foundation Gobbi NPO, Milan, Italy

    Alberto Gobbi

  3. ClĂ­nica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal

    JoĂŁo Espregueira-Mendes

  4. Cohen Institute, Sao Paulo, SĂŁo Paulo, Brazil

    Camila Cohen Kaleka

  5. Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan

    Nobuo Adachi

Rights and permissions

Reprints and permissions

Copyright information

© 2023 ISAKOS

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Abdelatif, N.M.N. (2023). Evaluation of Ankle Impingement. In: Lane, J.G., Gobbi, A., Espregueira-Mendes, J., Kaleka, C.C., Adachi, N. (eds) The Art of the Musculoskeletal Physical Exam. Springer, Cham. https://doi.org/10.1007/978-3-031-24404-9_60

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-24404-9_60

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-24403-2

  • Online ISBN: 978-3-031-24404-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation