uk/soft-tissue/impingement/
Impingement
When a piece of soft tissue becomes trapped between two pieces of bone.
What is it?
Impingement is when soft tissue becomes pinched between the bones in a
joint. In the ankle, there are two main types of impingement: anterior (in the
front of the ankle) and posterior (in the back of the ankle).
Repeated injuries can also cause the ankle bones to form small projections
called bone spurs. These can get caught in the soft tissue between the bones
when the foot is pulled upwards. This condition is also known as footballer's
ankle.
Posterior impingement can also be the result of ankle sprains: if the ankle is
unstable due to slack or torn ligaments, the heelbone and the tibia can slip
and trap soft tissue in between them, causing pain when the foot is pointed
downwards.
How does it feel?
Anterior impingement: pain in the front part of your ankle, which is likely to
feel worse as you pull your toes up towards you. You may also experience a
clicking sensation in the front of your ankle when moving your foot up and
down. Your ankle may also feel weak, as though you can't trust it to remain
stable during certain activities.
Posterior impingement: pain deep in the back of the ankle. There is usually
tenderness by the anklebone on the outside of the ankle. Pain is usually
worse when your foot is pointed down. You may also feel a painful clicking
sensation as your foot is twisted in and out.
Diagnosis
Anterior impingement: the surgeon will look for tenderness and swelling on
the front of your ankle. He will check to see if the pain increases when you
squat, lunge or pull your toes upwards. X-rays and scans will be taken to see
if it is a bone spur that is causing the impingement.
Surgery
Anterior impingement: two small incisions are made either side of the
impingement area, and using an arthroscope, the surgeon will use a small
shaver to clear away thickened or inflamed tissue. If there is a bone spur on
the anklebone or the shinbone, it will be removed.
After arthroscopy, you will be able to put weight on the foot almost
immediately, and will be having physiotherapy twice a week. You should
expect full recovery about six weeks after surgery.
After minimally invasive surgery, you will be in a splint for three weeks.
Physiotherapy will be needed for the next two to three months.