Posterior Ankle Impingement Syndrome
The ankle joint is a synovial hinge joint comprised of the tibia, fibula and talus (aka the talocrural joint), which glides on one another and have articular cartilage on the surface which cushions the impact of the tibia on the talus during weight bearing activities. The two movements that occur at this joint are plantarflexion (where the foot/ankle are pointed away from the body) and dorsiflexion (where the foot/ankle are pointed toward the body).
Ankle impingement is defined as pain in the ankle due to impingement in one of two areas: anterior and posterior. Posterior ankle impingement syndrome (PAIS) is a spectrum of clinical disorders characterized by posterior ankle pain during plantarflexion causing mechanical limitation of full ankle range of motion.
Causes
PAIS can be due to the entrapment of either an osseous (bony) and/or soft-tissue abnormality, or other anatomical variation from the talus between the tibia and the posterior aspect of the calcaneus (heel bone). PAIS more commonly develops in athletes who participate in sports that require repetitive plantarflexion (including cricket). PAIS may present acutely after a forced plantarflexion injury or chronically, due to overuse. More commonly, PAIS develops over time, 4-6 weeks after an acute injury is sustained because repetitive plantarflexion causes increased compression and force in the ankle.
Symptoms
Usually no pain whilst resting.
Sharp, dull and/or radiating pain.
Difficult to pinpoint exact location of pain.
Deep, posterior ankle pain cause by plantarflexion of the ankle.
Standard plain X-rays, CT, and MRI scans are useful for diagnosis confirmation if required.
Management
PAIS is initially treated with conservative management which is usually sufficient to assist in reducing pain and facilitating the healing process. Many options are available to further assist in improving function and returning athletes back to activity, including:
Relative rest from aggravating activities.
Medication, e.g. anti-inflammatories.
Modification of activities
Physiotherapy.
Injections.
Surgical management may be indicated for patients who have not responded after 3 months of conservative treatment. However, if the patient wants to return to activity or sport promptly, surgical intervention can be recommended early in the treatment process. Options would include either open or arthroscopic surgery.
If you feel your ankle is preventing you from playing your best in sports games, come in and see the team for a full assessment and management plan to help you get back on track!