Skip to main content
SpringerLink
Log in

Ankle impingement: a review of multimodality imaging approach

  • Review
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Ankle impingement is defined as entrapment of an anatomic structure that leads to pain and decreased range of motion of the ankle and can be classified as either soft tissue or osseous (Bassett et al. in J Bone Joint Surg Am 72:55–59, 1990). The impingement syndromes of the ankle are a group of painful disorders that limit full range of movement. Symptoms are due to compression of soft-tissues or osseous structures during particular movements (Ogilvie-Harris et al. in Arthroscopy 13:564–574, 1997). Osseous impingement can result from spur formation along the anterior margin of the distal tibia and talus or as a result of a prominent posterolateral talar process, the os trigonum. Soft-tissue impingement usually results from scarring and fibrosis associated with synovial, capsular, or ligamentous injury. Soft-tissue impingement most often occurs in the anterolateral gutter, the medial ankle, or in the region of the syndesmosis (Van den Bekerom and Raven in Knee Surg Sports Traumatol Arthrosc 15:465–471, 2007). The main impingement syndromes are anterolateral, anterior, anteromedial, posterior, and posteromedial impingement. These conditions arise from initial ankle injuries, which, in the subacute or chronic situation, lead to development of abnormal osseous and soft-tissue thickening within the ankle joint. The relative contributions of the osseous and soft-tissue abnormalities are variable, but whatever component is dominant there is physical impingement and painful limitation of ankle movement. Conventional radiography is usually the first imaging technique performer and allows assessment of any potential bone abnormality, particularly in anterior and posterior impingement. Computed tomography (CT) and isotope bone scanning have been largely superseded by magnetic resonance (MR) imaging. MR imaging can demonstrate osseous and soft-tissue edema in anterior or posterior impingement. MR imaging is the most useful imaging modality in evaluating suspected soft-tissue impingement or in excluding other ankle pathology such as an osteochondral lesion of the talus. MR imaging can reveal evidence of previous ligamentous injury and also can demonstrate thickened synovium, fibrosis, or adjacent reactive soft-tissue edema. Studies of conventional MR imaging have produced conflicting sensitivities and specificities in assessment of anterolateral impingement. CT and MR arthrographic techniques allow the most accurate assessment of the capsular recesses, albeit with important limitations in diagnosis of clinical impingement syndromes. In the majority of cases, ankle impingement is treated with conservative measures, with surgical debridement via arthroscopy or an open procedure reserved for patients who have refractory symptoms. In this article, we describe the clinical and potential imaging features, for the four main impingement syndromes of the ankle: anterolateral, anterior, anteromedial, posterior, and posteromedial impingement.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bassett FH, Gates HS, Billys JB et al (1990) Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain. J Bone Joint Surg Am 72:55–59

    PubMed  Google Scholar 

  2. Watson AD (2007) Ankle instability and impingement. Foot Ankle Clin 12:177–195

    Article  PubMed  Google Scholar 

  3. Ferkel RD, Karzel RP, Del Pizzo W et al (1991) Arthroscopic treatment of anterolateral impingement of the ankle. Am J Sports Med 19:440–446

    Article  PubMed  CAS  Google Scholar 

  4. Colao A, Cannavò S, Marzullo P, Pivonello R, Squadrito S, Vallone G, Almoto B, Bichisao E, Trimarchi F, Lombardi G (2003) Twelve months of treatment with octreotide‐LAR reduces joint thickness in acromegaly. Eur J Endocrinol 148(1):31–38

    Google Scholar 

  5. Lui HL, Raskin A, Osti L et al (1994) Arthroscopic treatment of anterolateral ankle impingement. Arthroscopy 10:215–218

    Article  Google Scholar 

  6. Lui HL, Nuccion SL, Finerman G (1997) Diagnosis of anterolateral ankle impingement: comparison between MRI and clinical examination. Am J Sports Med 25:389–393

    Article  Google Scholar 

  7. Cheung Y, Rosenberg ZS (2001) MRI imaging of ligamentous abnormalities of the ankle and foot. MRI Clin North Am 9:507–531

    CAS  Google Scholar 

  8. McMurray TP (1950) Footballer’s ankle. J Bone Joint Surg 32:68–69

    Google Scholar 

  9. Cutsuries AM, Saltrick KR, Wagner J et al (1994) Arthroscopic arthroplasty of the ankle joint. Clin Podiatr Med Surg 11:449–467

    PubMed  CAS  Google Scholar 

  10. Ferkel RD, Scranton PE Jr (1993) Arthroscopy of the ankle and foot. J Bone Joint Surg Am 75:1233–1242

    PubMed  CAS  Google Scholar 

  11. Ogilvie-Harris DJ, Mahomed N, Demaziere A (1993) Anterior impingement of the ankle treated by arthroscopic removal of bony spurs. J Bone Joint Surg Br 75:437–440

    PubMed  CAS  Google Scholar 

  12. O’Donoghue DH (1957) Impingement exostoses of the talus and tibia. J Bone Joint Surg Am 39-A:835–852

    PubMed  Google Scholar 

  13. Williams JM, Brandt KD (1984) Exercise increases osteophyte formation and diminishes fibrillation following chemically induced articular cartilage injury. J Anat 139(Pt 4):599–611

    PubMed  Google Scholar 

  14. Hawkins RB (1988) Arthroscopic treatment of sports-related anterior osteophytes in the ankle. Foot Ankle 9:87–90

    Article  PubMed  CAS  Google Scholar 

  15. van Dijk CN (1994) On diagnostic strategies in patients with severe ankle sprain. University of Amsterdam, Amsterdam

    Google Scholar 

  16. van Dijk CN, Bossuyt PM, Marti RK (1996) Medial ankle pain after lateral ligament rupture. J Bone Joint Surg Br 78:562–567

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  18. Niek van Dijk C (2006) Anterior and posterior ankle impingement. Foot Ankle Clin 11:663–683

  19. Genovese E, Angeretti MG, Ronga M, Leonardi A, Novario R, Callegari L, Fugazzola C (2007) Follow-up of collagen meniscus implants by MRI. Radiol Med 112(7):1036–1048

    Article  PubMed  CAS  Google Scholar 

  20. Ronga M, Grassi FA, Montoli C, Bulgheroni P, Genovese E, Cherubino P (2005) Treatment of deep cartilage defects of the ankle with matrix-induced autologous chondrocyte implantation (MACI). Foot Ankle Surg 11:29–33

    Article  Google Scholar 

  21. Macarini L, Murrone M, Marini S, Mocci A, Ettorre GC (2004) MRI in ACL reconstructive surgery with PDLLA bioabsorbable interference screws: evaluation of degradation and osteointegration processes of bioabsorbable screws. Radiol Med 107(1–2):47–57

    PubMed  Google Scholar 

  22. Basile A, Tsetis D, Cavalli M, Fiumara P, Di Raimondo F, Coppolino F, Coppolino C, Mundo E, Desiderio C, Granata A, Patti MT (2010) Sacroplasty for local or massive localization of multiple myeloma. Cardiovasc Intervent Radiol 33(6):1270–1277

    Article  PubMed  Google Scholar 

  23. Colao A, Marzullo P, Vallone G, Giaccio A, Ferone D, Rossi E, Scarpa R, Smaltino F, Lombardi G (1999) Ultrasonographic evidence of joint thickening reversibility in acromegalic patients treated with lanreotide for 12 months. Clin Endocrinol (Oxf) 51(5):611–618

    Article  CAS  Google Scholar 

  24. Robinson P, White LM (2002) Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management. Radiographics 22:1457–1471

    Article  PubMed  Google Scholar 

  25. Umans H (2002) Ankle Impingement syndromes. Semin Musculoskelet Radiol 6:133–139

    Article  PubMed  Google Scholar 

  26. Haller J, Bernt R, Seeger T et al (2006) MR-imaging of anterior tibiotalar impingement syndrome: agreement, sensitivity and specificity of MR-imaging and indirect-arthrography. Eur J Radiol 58:450–460

    Article  PubMed  Google Scholar 

  27. Tol JL, Verheyen CPPM, Van Dijk CN (2001) Arthroscopic treatment of anterior impingement in the ankle: a prospective study with a five-to-eight year follow-up. J Bone Joint Surg Br 83:9–13

    Article  PubMed  CAS  Google Scholar 

  28. Colao A, Pivonello R, Scarpa R, Vallone G, Ruosi C, Lombardi G (2005) The acromegalic arthropathy. J Endocrinol Invest 28(8 Suppl):24–31

    Google Scholar 

  29. Mosier-La Clair SM, Monroe MT, Manoli A (2000) Medial impingement syndrome of the anterior tibiotalar fascicle of the deltoid ligament on the talus. Foot Ankle Int 21:385–391

    PubMed  CAS  Google Scholar 

  30. Egol KA, Parisien JS (1997) Impingement syndrome of the ankle caused by a medial meniscoid lesion. Arthroscopy 13:522–525

    Article  PubMed  CAS  Google Scholar 

  31. Chilvers M, Donahue M, Nassar L, Manoli A II (2007) Foot and ankle injuries in elite female gymnasts. Foot Ankle Int 28(2):214–218

    Article  PubMed  Google Scholar 

  32. Vann MA 2nd, Manoli A II (2010) Medial ankle impingement in female gymnasts. Oper Tech Sports Med 18(1):50–52

    Article  Google Scholar 

  33. Nappi C, Greco E, Anichini C, Guerra G, Di Spiezio Sardo A (2008) Pregnancy in a gerodermia osteodysplastica patient: a case report. Am J Obstet Gynecol 198(1):e17–e19

    Google Scholar 

  34. Nurzynska D, Di Meglio F, Castaldo C, Latino F, Romano V, Miraglia R, Guerra G, Brunese L, Montagnani S (2012) Flatfoot in children: anatomy of decision making. Ital J Anat Embriol 117(2):98–106

    Google Scholar 

  35. Robinson P, White LM, Salonen D et al (2002) Anteromedial impingement of the ankle: using MR arthrography to assess the anteromedial recess. AJR Am J Roentgenol 178:601–604

    Article  PubMed  CAS  Google Scholar 

  36. van Dijk CN, Lim LS, Poortman A et al (1995) Degenerative joint disease in female ballet dancers. Am J Sports Med 23:295–300

    Article  PubMed  Google Scholar 

  37. Stibbe AB, Van Dijk CN, Marti RK (1994) The os trigonum syndrome. Acta Orthop Scand (Suppl 262):59–60

  38. Hamilton WG, Geppert MJ, Thompson FM (1996) Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment. J Bone Joint Surg Am 78:1491–1500

    PubMed  CAS  Google Scholar 

  39. Hedrick MR, McBryde AM (1994) Posterior ankle impingement. Foot Ankle Int 15:2–8

    Article  PubMed  CAS  Google Scholar 

  40. Pinto A, Caranci F, Romano L, Carrafiello G, Fonio P, Brunese L (2012) Learning from errors in radiology: a comprehensive review. Semin Ultrasound CT MRI 33(4):379–382

    Google Scholar 

  41. Karasick D, Schweitzer ME (1996) The os trigonum syndrome: imaging features. AJR Am J Roentgenol 166:125–129

    Article  PubMed  CAS  Google Scholar 

  42. Bureau NJ, Cardinal E, Hobden R, Aubin B (2000) Posterior ankle impingement syndrome: MR imaging findings in seven patients. Radiology 215:497–503

    PubMed  CAS  Google Scholar 

  43. Grogan DP, Walling AK, Ogden JA (1990) Anatomy of the os trigonum. J Pediatr Orthop 10:618–622

    Article  PubMed  CAS  Google Scholar 

  44. Liu SH, Mirzayan R (1993) Posteromedial ankle impingement. Arthroscopy 9:709–711

    Article  PubMed  CAS  Google Scholar 

  45. Messiou C, Robinson P, O’Connor PJ et al (2006) Subacute posteromedial impingement of the ankle in athletes: MR imaging evaluation and ultrasound guided therapy. Skeletal Radiol 35:88–94

    Article  PubMed  Google Scholar 

  46. Paterson RS, Brown JN, Roberts SNJ (2001) The posteromedial impingement lesion of the ankle: a series of six cases. Am J Sports Med 29:550–557

    PubMed  CAS  Google Scholar 

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

    Google Scholar 

  48. Robinson P, White LM (2002) Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management. Radiographics 22(6):1457–1469 (discussion 1470–1471)

    Article  PubMed  Google Scholar 

  49. Lubrano E, Marchesoni A, Olivieri I, D’Angelo S, Palazzi C, Scarpa R, Ferrara N, Parsons WJ, Brunese L, Helliwell PS, Spadaro A (2012) The radiological assessment of axial involvement in psoriatic arthritis. J Rheumatol 39(Suppl 89):54–56

    Google Scholar 

  50. Dhillon MS, Bali K, Prabhakar S (2011) Controversies in calcaneus fracture management: a systematic review of the literature. Musculoskelet Surg 95:171–181

    Article  PubMed  Google Scholar 

  51. Ogilvie-Harris DJ, Gilbart MK, Chorney K (1997) Chronic pain following ankle sprains in athletes: the role of arthroscopic surgery. Arthroscopy 13:564–574

    Article  PubMed  CAS  Google Scholar 

  52. Van den Bekerom MPJ, Raven EEJ (2007) The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiofibular impingement syndrome: a current concepts review. Knee Surg Sports Traumatol Arthrosc 15:465–471

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Alessandra Trocino, Librarian at the Library of NCI G Pascale Foundation of Naples, Italy, for her excellent bibliographic service and assistance.

Conflict of interest

A. Russo, M. Zappia, A. Reginelli, M. Carfora, G. F. D’Agosto, M. La Porta, E.A.Genovese, P. Fonio declare that they have no conflict of interest.

Ethical standards

The study described in this article did not include any procedures involving humans or animal.

Author information

Authors and Affiliations

  1. Department of Radiology, S. G. Moscati Hospital, Aversa, Italy

    A. Russo

  2. Department of Health and Science, University of Molise, Campobasso, Italy

    M. Zappia

  3. Department of Clinical and Experimental Internistic F. Magrassi, Second University of Naples, Naples, Italy

    A. Reginelli & M. Carfora

  4. Department of Radiology, Medicanova Diagnostic, Battipaglia, Italy

    G. F. D’Agosto

  5. Department of Radiology, San Severo Hospital, Foggia, Italy

    M. La Porta

  6. Department of Radiology, University of Cagliari, Cagliari, Italy

    E. A. Genovese

  7. Institute of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy

    P. Fonio

Authors
  1. A. Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Zappia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Reginelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Carfora
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. F. D’Agosto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. La Porta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. A. Genovese
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Fonio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Russo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Russo, A., Zappia, M., Reginelli, A. et al. Ankle impingement: a review of multimodality imaging approach. Musculoskelet Surg 97 (Suppl 2), 161–168 (2013). https://doi.org/10.1007/s12306-013-0286-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-013-0286-8

Keywords

Search

Navigation