What is impingement?

Ankle impingement occurs when the synovial lining of the joint is pinched between 2 bones.

At the front and back of the ankle the talus and tibia move together during ankle motion. As the bones move closer they pinch the soft tissue or impinge against each other.

This can also occur on the inside and outside of the ankle.

Ankle Impingement Anterior ankle

  • Bone spurs
    • can develop spontaneously
    • often associated with ankle sprains
  • Soft tissue scarring after an ankle injury or surgery
  • Spurs associated with early ankle arthritis

Ankle ImpingementPosterior ankle

Similar impingement in the back of the ankle can occur due to:

  • Prominent posterior talus process
  • Os trigonum
  • Soft tissue scarring

What are the symptoms?

  • Pain at the site of impingement
  • Swelling
  • Stiffness
  • Sharp catching sensation which is positional depending on the site of impingement.
    • Anterior pain with squatting or going up stairs or a slope
    • Posterior pain when the toes are pointed.

Symptoms often develop after a minor injury which inflames the lining of the joint causing it more likely to be pinched.

Patients with anterior impingement may feel better in a shoe with a heel.

What is the non-surgical treatment?

  • Simple pain relief
  • Activity modification.
  • Heel raise
    • This opens the space between the talus and tibia reducing the anterior impingement.
  • Steroid injection
    • Helpful after an injury
    • Reduces the inflammation and also any soft tissue impingement.
  • Physiotherapy is very important if there has been an associated ankle sprain and instability.
  • What is the surgical treatment?

    Surgery involves an arthroscopy of the ankle. The bone spurs are removed. Any scar tissue or inflammation is also removed.

    This is performed through two small incisions on the front of the ankle for anterior, medial or lateral impingment.

    For posterior impingement, surgery is performed from the back of the ankle.

    This surgery is successful in approximately 80% of cases in relieving symptoms.

    If there is associated ankle instability surgery to reconstruct the ligaments may also be required.

    What does the rehabilitation involve?

    • Day surgery
    • You will have a bulky bandage that can be removed after 48 hours to allow regular application of ice.
    • 2 weeks with the foot elevated the majority of time.
    • Full weight-bearing
    • You may be provided with a boot to wear fulltime for 2 days then at night only for the first 2 weeks
    • You will be seen in Mr Curry’s rooms at 2 weeks where you will see Mr Curry and our Nurse Practitioner who will remove sutures
    • Physiotherapy will be required for a range of motion program progressing to a strength and balance program as tolerated
    • By 6 weeks you will be back to most activities.
    • The final result and swelling resolution may take 3-4 months

    How long will I be off work?

    This is dependent upon your occupation

    • Seated job 2 weeks
    • Standing job 4-6 weeks
    • Heavy lifting job 8-10 weeks

    When can I drive?

    It is recommended you do not drive for 2 weeks.

    What are the risks of the procedure?

    General risks of surgery

    • Infection
    • Wound healing problems
    • Nerve injury and scar sensitivity
    • Blood clots to the leg
    • Anaesthetic problems

    Specific to surgery for bony impingement

    • Recurrence of bony spurs
    • Development of scar tissue that causes soft tissue impingement.
    This information is an overview of ankle impingement and is not all inclusive.

    If you have any questions please contact Mr Curry’s rooms on (03) 99286560