Anterior Ankle Impingement Syndrome 715.17

 

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

    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

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