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Ankle Impingement Syndrome

Ankle Impingement Syndrome. initial ankle injury abnormal osseous & soft tissue thickening in the subacute or chronic situation chronic ankle pain , painful limitation of ankle movement. Ankle Impingement Syndrome. Anterolateral Impingement Anterior Impingement Anteromedial Impingement

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Ankle Impingement Syndrome

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  1. Ankle Impingement Syndrome • initial ankle injury • abnormal osseous & soft tissue thickening in the subacute or chronic situation • chronic ankle pain , painful limitation of ankle movement

  2. Ankle Impingement Syndrome • Anterolateral Impingement • Anterior Impingement • Anteromedial Impingement • Posterior Impingement

  3. Posterior Impingement • Anatomy and Causes • secondary ossification center : • - 7-13 years, usually fuses within 1 year- large lateral talar process (Stieda process)- failure of fusion (os trigonum)

  4. Posterior Impingement • Anatomy and Causes • compression of soft tissue between posterior process of calcaneus and posterior tibia on plantar flexion of ankle • lateral posterior process of talus • os trigonum • chronic injuryrepetitive forced plantar flexion(usually) • acute injury avulsion fx of PTaF ligament, talar fx disruption of os trigonum

  5. Lateral talar tubercle

  6. Os trigonum

  7. Posterior Impingement • Clinical features • posterior ankle painexacerbated by plantar flexion or dorsiflexion • posterior tenderness anterior to and not involving Axchilles tendon • palpable soft tissue thickening

  8. Posterior Impingement • Imaging features : Plain, CT, US • prominent lateral talar process or os trigonum • fracture not evident on plain radiography • symptomatic os trigonum :↑ activitynegative scan excludes this diagnosis

  9. Posterior Impingement • Imaging features : MRI • bone abnormalitybone marrow edema in lateral talar tubercle or os trigonumfracture line or fluid in synchondrosis (os trigonum fracture) • posterior capsular or ligament thickeninglow to intermediate SI on T2-WI • Synovitis • posterior synovial recess of subtalar and tibiotalar joint • FHL tendon sheath

  10. Posterior Impingement • Management • rehabilitative physiotherapy • imaging guided injection of steroid or local anesthetic into area of focal capsular thickening or os trigonum synchondrosis • surgical treatmentarthroscopic resection of osseous abnormaluty and soft tissue abnormality with washout of joint

  11. Posterior ankle ligament

  12. Posterior Impingement Prominent lateral talar tubercle focal thickening of posterior capsule

  13. Posterior Impingement focal thickening of posterior capsule adjacent to posterior talus (T)

  14. Posterior Impingement BM edema within os trigonum

  15. Posterior Impingement focal thickening of posterior capsule

  16. Posterior Impingement Prominent os trigonum BM edema in posterior talus

  17. Posterior Impingement limited plantar flexion BM edema in posterior talus and adjacent bone fragment

  18. Posterior Impingement BM edema in posterior talus and adjacent bone fragment fragmentation of lateral talar tubercle

  19. Posterior Impingement BM edema in posterior talus Inflammation of posterior recess of tibiotalar and subtalar joint Incomplete fracture with osteosclerosis

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