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Anterior impingement syndrome

Definition

With this, you complain of pain at the front of the ankle joint.

Symptoms

The pain may be experienced as a band from the outside to the inside of the ankle or as a pain in one specific place at very specific movements.
From time to time we diagnose a motion restriction in dorsiflexion during clinical trial.
The palpation of the lining of the joint by the surgeon allows you to feel the known pain.

Causes

The pain is caused by inflammation of certain structures of the joint, which are chronically irritated by repetitive movements, often after experiencing a trauma, such as a “trivial” sprain or an ankle fracture. Typically this is also found in football players who always kick the ball with the inside of the ankle and thus cause bone growth in that region, which in turn inflames the soft tissues. In some cases, the bone growth can be due to underlying osteoarthritis of the ankle.

Diagnosis

The diagnosis is mainly clinical, if one can generate the pains you know. Additional examination can be:

  • radiographs;
  • a scan with or without an intra-articular injection of cortisone if cartilage damage or loose fragments are suspected;
  • and / or a magnetic resonance.

Treatment

Initially, treatment is symptomatic, which means that with the help of physiotherapy attempts are made to reduce the inflammation locally.
In case of persistent pain, an injection at the painful spot is suggested, with the aim of reconfirming the diagnosis, but mainly because about 60% of the patients are permanently helped.
In those patients whose symptoms unfortunately recur, despite an injection, arthroscopy may be suggested. The debridement of the front part of the ankle joint is done through two small skin incisions, and this in one day surgery.
video : conflit-ant-preop-fig-26.mpg

video : conflit-ant-postop-fig-27.mpg

Postoperative policy

To avoid that the hematoma, which inevitably develops after surgery, will cause the same symptoms, it is strongly recommended to move the ankle into the extremes of movement immediately after waking up.
One can also immediately lean on the ankle, except when a cartilage injury was operated during the same surgery.