"Web impingement" of the ankle: a case report

Update on Ankle and Foot Impingement

Ankle impingement syndromes are a well-recognized cause of chronic ankle symptoms in both the elite athletic and general population. They comprise several distinct clinical entities with associated radiologic findings. Originally described in the 1950s, advances in magnetic resonance imaging (MRI) and ultrasonography have allowed musculoskeletal (MSK) radiologists to further their understanding of these syndromes and the range of imaging-associated features. Many subtypes of ankle impingement syndromes have been described, and precise terminology is critical to carefully separate these conditions and thus guide treatment options. These are divided broadly into intra-articular and extra-articular types, as well as location around the ankle. Although MSK radiologists should be aware of these conditions, the diagnosis remains largely clinical, with plain film or MRI used to confirm the diagnosis or assess a surgical/treatment target. The ankle impingement syndromes are a heterogeneous group of conditions, and care must be taken not to overcall findings. The clinical context remains paramount. Treatment considerations are patient symptoms, examination, and imaging findings, in addition to the patient's desired level of physical activity.

Intra-articular fibrous bands at the tibiotalar joint: diagnosis and outcomes of arthroscopic removal in 4 ankles

The authors retrieved the records of 4 patients that exhibited unusual structural anomalies or pathologies, notably the presence of a fibrous band at the anterior aspect of the tibiotalar joint, observed during arthroscopic exploration or treatment between January and December 2019. Only 1 patient had surgical antecedents on the ipsilateral ankle (extra-articular tenodesis 10 years earlier). The remaining 3 patients had no surgical antecedents on the ipsilateral ankle. The fibrous band was removed in all patients during arthroscopic Brostöm procedure or exploration. For the first 3 patients, the intra-articular fibrous band was not observed prior to arthroscopy by either the senior surgeon or radiologist on any of the images (2 MRIs and 1 CTA), but retrospective inspection confirmed that the intra-articular fibrous band was present but had been overlooked.

At a follow-up of 22.3 ± 5.0 months (range, 15–26), all patients reported a decrease in pVAS (− 5.0 ± 2.6, range, 2–8), and an improvement in AOFAS (51.0 ± 17.7, range, 26–65), EFAS (14.5 ± 8.7, range, 6–23) and EFAS sport (8.0 ± 5.3, range, 2–10).

This case report corroborates the findings of an earlier discovery of an intra-articular fibrous band in 4 ankles, with more detailed information for clinical and radiologic diagnosis, as well as outcomes of arthroscopic removal. Clinicians should beware of such foreign bodies in the ankle, particularly in patients with history of sprains, and consider arthroscopic removal in cases with persistent pain and/or functional impairment.

Effect of a novel mobilization with movement procedure on anterolateral ankle impingement - A case report

This case report describes a 50-year-old male who presented with right anterolateral ankle pain managed unsuccessfully with rest, medications, bracing, injection, physical therapy, and massage therapy. Clinical diagnosis of anterolateral ankle impingement was based on concordant symptom reproduction with palpatory tenderness and a positive lateral synovial impingement test. This case report is a potential first time description of the successful management of anterolateral ankle impingement utilizing a novel Mulligan's mobilization with movement procedure (consisting of internal rotation of the distal tibia) and taping with immediate improvements noted in pain, range of motion, and function. The patient was seen twice a week and was discharged after four treatment sessions. A follow-up after 4 months revealed that the patient was pain free and fully functional.

MR Imaging of Impingement and Entrapment Syndromes of the Foot and Ankle

Impingement is a clinical syndrome of chronic pain and restricted range of movement caused by compression of abnormal bone or soft tissue within the ankle joint. It usually occurs following a sprain injury or repetitive microtrauma causing haemorrhage, synovial hyperplasia, and abnormal soft tissue interposition within the joint. MR imaging is particularly valuable in being able to detect not only the soft tissue and osseous abnormalities involved in these syndromes, but also a wide variety of other potential causes of ankle pain and instability that also may need to be addressed clinically.

Ankle impingement

Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed.

Intra-articular post-traumatic ankle joint mass imitating localized pigmented villonodular synovitis (LPVS), the aid of ankle arthroscopy for diagnosis and treatment-a case report

Intra-articular post-traumatic ankle joint mass is a rare entity that may mimic other pathologies, mainly localized form of pigmented villonodular synovitis (LPVS) regarding the clinical and imaging characteristics. We report the case of a 16-year-old female patient that presented an intra-articular ankle joint mass 8 months after an ankle joint sprain for which magnetic resonance imaging (MRI) suggested LPVS as possible diagnosis due to the presence of hemosiderin deposits. Diagnosis of a post-traumatic hematoma of her ankle joint was made via fine needle aspiration (FNA) biopsy and anterior ankle arthroscopy. At one-year-follow-up after the arthroscopic excision of the hematoma, the patient remained asymptomatic and pain free while MRI revealed no pathologic findings. This case demonstrates that LPVS is not always the diagnosis when hemosiderin deposits are depicted on the MRI of a solitary intra-articular mass. The FNA biopsy under direct arthroscopic view assists the diagnosis and guides the treatment plan in cases that no definite diagnosis has been reached preoperatively by MRI. Level of evidence IV, case report.

Safety of ankle arthroscopy for the treatment of anterolateral soft-tissue impingement

PURPOSE

To quantify the overall incidence of complications related to arthroscopic treatment of anterolateral soft-tissue ankle impingement.

METHODS

Electronic databases and relevant peer-reviewed sources, including OvidSP/Medline (http://ovidsp.tx.ovid.com) and Google Scholar, were systematically searched for the terms "anterolateral" AND "ankle" AND "impingement" OR "soft-tissue impingement" AND "arthroscopy." In addition, we manually searched common American and European (including British) orthopaedic and podiatric scientific literature for relevant articles. Studies were eligible for inclusion only if they included the following: a standard 2-portal anterior arthroscopic approach, a minimum mean follow-up of 12 months, and detailed descriptions of all complications encountered.

RESULTS

After we considered all the potentially eligible articles, 15 (28.8%) met our inclusion criteria for the study. There were a total of 396 patients (397 ankles), with 16 total complications (4%), 3 (0.8%) of which were major. The weighted mean patient age was 31.2 years, and the weighted mean follow-up was 33.7 months.

CONCLUSIONS

The results of this systematic review showed an overall incidence of complications of 4%. The complications were categorically divided into major and minor complications, with a very low incidence of major complications (0.8%) and an acceptably low incidence of minor complications (3.3%). On the basis of these findings, arthroscopic treatment of anterolateral ankle soft-tissue impingement is a very safe procedure when indicated.

LEVEL OF EVIDENCE

Level IV, systematic review of Level IV studies.