Anterior Ankle Impingement Syndrome

synonyms:

Anterior Impingment ICD-9

• 715.17(osteoarthrosis and allied disorders, localized, primary, ankle and foot.

Anterior Impingment Etiology / Epidemiology / Natural History

Anterior Impingment Anatomy

• See also Ankle Anatomy.

Anterior Impingment Clinical Evaluation

• Pain with dorsiflexion activities, anterior ankle pain with forced dorsiflexion, anterior joint line tenderness

Anterior Impingement Xray

• exostosis on anterior tibia, +/- kissing lesion    

Anterior Impingement Classification/Treatment

• type I: synovitis, minimal exostosis, RX-NSAIDS, heel lift vs arthroscopic debridement
• type II: osteochondral reaction, 3mm exostosis RX-scope
• type III:tibial exostosis + talar kissing lesion, +/-fragmentation RX: scope vs open exostectomy/debridement
• type IV:degenerative joint changes.  RX:fusion
• Arthroscopic exostectomy/debridement: anterior medial and anterloateral (risk superficial peroneal nerve) portals.  1/4” osteotome via medial portal removes exostosis, debride with full radius shaver.  90% good to excellent results with return to sports
• Open exostectomy= antermedial incision just medial to TA tendon vs anteriolateral incision depending on exostosis location
• Patient Guides: eOrthopod,

Anterior Impingement Associated Injuries / Differential Diagnosis

• Os Trigonum Syndrome
• Ankle arthritis
• Anterior tibial tendon tenosynovitis
• Cuboid Stress Fracture
• Navicular Stress Fx
• Kohler's Disease
• Sinus Tarsi Syndrome
• Tarsal Coalition

Ankle Scope Complications

• Neurologic (primarily superficial branch of peroneal N, saphenous N or sural N
• Vascular injury
• Superficial/deep infection
• Adhesions
• Fracture
• Ligament injur
• Incisional pain

Anterior Impingement Follow up  care

• Cast brace for 1-2 wks with PT for 3weeks

Anterior Impingement References

1. Parks JC J Trauma 20:896, 1980
2. Scranton PE, Foot Ankle 13:125, 1992