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Anterior Ankle Impingement Syndrome M19.079 715.17

 Ankle Anterior impingement xray

synonyms:ankle impingement, anterior ankle impingement

Anterior Impingment ICD-10

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 

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