Anterior Ankle Impingement
image from www.sportsinjuryclinic.net
Introduction
Anterior ankle impingement is a common injury seen in football players and ballet dancers. Due to the repetitive nature of pile and demi-pile within ballet and striking of a ball within football, the micro trauma caused by these motions cause the athlete to be at higher risk of attaining anterior ankle impingement than any other athletes (O’Kane & Kadel, 2008) The repetitive micro trauma to the anterior aspect of the talocrural joint may cause osseous bone formation, ligament and soft tissue entrapment, and even capsulitis (Russell et al., 2012). Most commonly seen within a stereotypical anterior ankle impingement is an osseous formation (Bahr, R. & Maehlum, 2004; Brukner, P. and Khan, 2012). Hess, (2011) and Russell et al.(2012) state that osseous formations mainly occur due to the damage to the cartilage rims of the talus and tibia (talocrural joint); unlike previously suggested by Molloy et al., (2003)that the source of this osseous formation is due to the repetitive stretch which is placed onto the synovial capsule.
Anatomy of the Ankle Joint
Talo-crural Joint
image from clinicalgate.com
The Talocrural joint consists of the congruent movement of the talus and the tibial plafond created by the tibia and fibula. This joint is commonly known as a hinge point due to its main movement’s only being Plantar flexion and dorsiflexion. The joint is made stable by the lateral ligaments, deltoid ligaments as well as the surrounding capsules and muscles. On an individual bases there are three ligaments which support the ankle laterally, these are; the anterior talofibular ligament, the calcaneul-fibular ligament, and the posterior talofibular ligament. Medially the deltoid ligaments consist of four individual ligaments, which consist of, the: tibio-navicular joint, talo-calacaneal ligament, anterior tibiotalar ligament, and the posterior tibiotalar ligament.
Sub-talar joint
image from www.aofas.org
In similarity to the talocrural joint both the lateral ligaments, the deltoid ligaments, the capsule and surrounding muscles, indirectly support the sub-talar joint. The sub-talar joint is a gliding joint, which only allows for inversion and eversion. With both the sub-talar joint and the talocrural joint working in conjunction with each other it allows for multidirectional movements such as plantar flexion and inversion as well as dorsiflexion and eversion. Commonly it is known that plantar flexion and inversion is the mechanism of injury for the tear/rupture of the anterior talofibular ligament (ATFL).Other Possible injuries to the ankle:
Retro calcaneal Bursitis.
Achilles tendinopathy.https://www.youtube.com/watch?v=oUkmYRnHm9I
Posterior ankle impingement.
Fractures
Muscular Tears
Ligament Tears (most common is a lateral ankle sprain of the ATFL)
Tenosynovitis of the tendon sheaths
Above are only a few injuries, which may happen to the ankle joint.
Hope you enjoy reading this blog and there will be more to follow in the coming weeks.
References
Bahr, R. & Maehlum, S. (2004) Clinical guide to sports injuries. Champaign, IL: Human Kinetics.
Brukner, P. and Khan, K. (2012) Brukner & Khan’s Clinical Sports Medicine. (4th Ed.) Australia: McGraw-Hill Medical.
Hess, G.W. (2011) Ankle Impingement Syndromes: A Review of Etiology and Related Implications. Foot & Ankle Specialist. Vol. 4, No. 5: 290–297.
Molloy, S., Solan, M.C. & Bendall, S.P. (2003) Synovial impingement in the ankle. A new physical sign. The Journal of Bone and Joint Surgery. British Volume. Vol. 85, No. 3: 330–3. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/12729103.
O’Kane, J.W. & Kadel, N. (2008) Anterior impingement syndrome in dancers. Current Reviews in Musculoskeletal Medicine. Vol. 1, No. 1: 12–16.
Russell, J.A., Kruse, D.W., Koutedakis, Y. & Wyon, M.A. (2012) Pathoanatomy of Anterior Ankle Impingement in Dancers. Journal of Dance Medicine & Science. Vol. 16, No. 3: 101–110.