Posterior Impingement of the Ankle

Patients with posterior impingement of the ankle oftentimes complain of pain in the posterior, or back of, the ankle. There may be an associated snap or catching sensation along with it, which may be caused by the tendon which lies next to this area, called the FHL (Flexor Hallucis Longus). Along with physical examination and plain x-rays, an MRI may be useful in making the diagnosis. The nonoperative treatment typically consists of NSAIDS, injections, and rest. If these fail, an endoscopic surgical technique may be used to remove the excess bone (Os trigonum or trigonal process) with release of the FHL (Flexor Hallucis Longus) tendon. This endoscopic technique is a minimally invasive technique that has the potential advantages of less bleeding, faster recovery, less scarring, and less pain.

Arthroscopy for ankle fractures?

When is ankle arthroscopy recommendable for ankle fractures? There are two randomized studies published on the use of arthroscopy in ankle fractures. One study demonstrated better results in patients who underwent arthroscopy at the time of open reduction internal fixation and the second study demonstrated equivalent results. Based on this data, I do not perform an ankle arthroscopy on all patients who have had an ankle fracture. With patient specific factors also considered, I tend to perform the arthroscopy on higher energy injuries, such as ankle subluxations or dislocations or syndesmosis injuries. At the time of arthroscopy, Ferkel reported a high rate of damage to the articular surfaces following ankle fractures, and my experience supports this fact. At the time of arthroscopy, loose bodies of cartilage alone or a combination of cartilage and bone can be treated, and the joint is looked at thoroughly to identify and treat any other associated injuries. This damage to the inside of the joint can be a cause of chronic pain if left untreated.

Ankle arthroscopy

What problems can be treated with ankle arthroscopy?

There are a number of different problems which are effectively treated with ankle arthroscopy. These reasons, or indications, are meant to serve as a guideline of the most common indications for ankle arthroscopy. Osteochondral defects or lesions, which are focal areas of articular cartilage damage on either side of the ankle joint (the tibia or more commonly the talus) may be treated with ankle arthroscopy. Anterior impingement, resulting from either excess bone or soft tissue along the front of the ankle joint, is most commonly seen in athletes. Loose bodies, which are loose pieces of bone or cartilage, may be removed. Septic arthritis, or infection of the ankle joint, also may be treated effectively, along with antibiotics afterwards.