The Center for Podiatric Care and Sports Medicine

My Ankle Is Being Impinged

Posted by on Monday, May 14th, 2012

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The hinge of a door rarely causes you any problems. Sure, maybe it might squeak a little bit, but that’s no big deal. A little WD-40 and voila, the problem is solved.

Your ankle joint is a kind of hinge, too, but it can run into a whole angry beehive of troubles. Granted, your ankle also works a lot harder than a door hinge. It connects your leg and your foot. It makes your foot bend up, down, and side to side (you probably don’t use that one much, but your ankle can do it!). It’s part of every step you take. So bravo, ankle joint! No wonder you can incur all these weird injuries!

And today’s weird ankle joint injury is….ankle impingement!

Are you serious? There’s an injury called an ankle impingement? What the heck is that? We’re going to have to talk a little anatomy here, so put your fake med student caps on (is it a pointy cap? I hope so).

There is a ligament that runs around the front of your ankle. It connects the tibia, the big long shin bone, to the fibula, the thinner bone next to it. That’s called the anterior inferior tibiofibular ligament, or the AITFL for those of you who don’t like to type. There’s also a ligament called the anterior talofibular ligament (ATFL) that connects the fibula to the talus, the chunky bone that rests on the calcaneus, or heel bone. These ligaments help support the ankle. If these ligaments become irritated and thickened, they can get pinched between the talus and tibia, causing an anterior impingement. You feel it when you point your foot up. This can also be caused when an ankle injury, such as a bad sprain, leads to the formation of too much scar tissue that gets caught in the ankle joint. Bone spurs that form on the tibia or talus after a bad injury can also poke into soft tissues when you flex your foot up, causing pain and irritation.

But wait, there’s more—a posterior impingement! You know that bumpy bone on the outside of your ankle? That’s a lateral tuberosity (the smaller bump on the inside of your ankle is a medial tuberosity). These are supposed to be part of the talus, but in some people it’s a separate piece called an os trigonum. When people who have an os trigonum point their feet downwards, the os trigonum can get caught between the talus and the calcaneus, causing a posterior impingement, or os trigonum syndrome. I know, this has all been quite a workout for the p sound.

(Note: did you know that pointing your foot up is called dorsiflexion and pointing it down is called plantarflexion? Am I the only person who thinks of seahorses when I hear or see these words? I have a feeling I am.)

Got all that?

Is this going to be on the quiz? No.

Okay, yeah, got it. So what causes this? I’d like to avoid an ankle impingement so I don’t have to spew out all these terms. Well, as we noted above, anterior impingements are usually the after effect of a bad sprain or series of sprains. They’re common in people who spend a lot of time with their feet flexed or pointed upwards (or dorsiflexed). Think catchers in baseball squatting, dancers doing plies, football players and basketball players jumping and landing.

Posterior impingements are pretty rare–they really only occur in ballet dancers, who point their feet downwards in a super extreme position…then dance on them. Dancers who have had bad ankle sprains can also suffer from ankle instability that allows the talus to slide forward and pinch the tissues between the talus and tibia, thus impinging it.

The short answer (at last!) is that if you have had bad ankle sprains and either point your feet up or down a lot, you’re at risk for an impingement.

How do I know I have them? At last! An easy question. If your ankle feels unstable, you have irritation in the front of the ankle that gets worse when you point your foot up, you may have an anterior impingement; if you feel pain in the back of your heel when you point your foot downwards, then you probably have a posterior impingement. If you have either of these kinds of pain, particularly after a sprained ankle, you should see a podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900) to get an accurate diagnosis.

How would I cure this? I like being able to point my foot around without pain. That’s one of the perks of having an ankle joint. Indeed it is. First your doctor will try to treat the problem by resting your ankle, possibly with a walking boot or light cast. You may also apply ice to the painful area and take anti-inflammatories to bring down the irritation. Afterwards, you might need physical therapy to help regain full ankle mobility.

If that doesn’t work, though, a podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900) may decide surgery is necessary. Surgery for anterior impingements usually involves shaving away irritated tissue and bone spurs. Posterior impingement surgery usually means removal of the os trigonum. After surgery, you’ll have to have an ankle splint for a few weeks. After the area heals up, you’ll need physical therapy to get back ankle mobility.

Impinge can mean to encroach, or move stealthily into an area that’s not yours, and that indeed is what all these injuries involve: tissues, ligaments, and os trigonums getting into each others’ space and irritating everything around them. If you have pain in your ankle that might be an impingement, or any other foot issue, contact The Center for Podiatric Care and Sports Medicine. Dr. Josef J. GeldwertDr. Katherine Lai, and Dr. Ryan Minara have helped thousands of people get back on their feet.

 

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.