Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Posterior Inpingement of the Ankle

SYMPTOMS

There is a gradually increasing stiffness of the ankle and exercise-induced pain around the posterior part of the ankle joint, sometimes after previous sprain. This injury often affects footballers and ballet dancers.

AETIOLOGY

Impingement syndrome is not a diagnosis but a symptom and may be caused by repetitive injury to the posterior ankle joint, for example from repetitive plantar flexions striking footballs or dancing on tiptoe thus compressing the posterior compartment. Several underlying pathoanatomical factors can cause posterior impingement, including fibrosis, synovitis or an Os Trigonum.

CLINICAL FINDINGS

There is sometimes effusion and localised tenderness on palpation over the posterior ankle deep in front of the Achilles tendon. It is provoked during forced plantar-flexion.

INVESTIGATIONS

X-ray can show an Os Trigonum. MRI may show soft tissue oedema sometimes around the Os Trigonum.

TREATMENT

Orthotics and adjustment in techniques may be tried. NSAID can give short-term relief, as can a local cortisone injection. If there are persistent or severe symptoms, surgery with excision of impinged structures is recommended and curative.

REFERRALS

Refer to Dr Kevin Yip, orthopaedic surgeon in difficult cases.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities using well-fitting shoes. If there is pain on impact suggest low-impact activities such as cycling and swimming.

EVALUATION OF TREATMENT OUTCOMES

Monitor decrease of clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Several underlying problems can cause posterior impingement, including loose bodies, fibrosis, chondral flap tears, syno vitis or impinging soft tissue flaps or conditions around the Achilles tendon such as bursitis or tendinosis.

PROGNOSIS

Excellent if treated properly.

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