What Is Posterior Ankle Impingement & Who Is At Risk For Developing It?
Posterior Ankle Impingement is a painful condition which an individual experiences at the back part of the ankle as a result of compression of the bone or other soft tissue structures due to excessive plantar flexion of the foot. People most at risk for a Posterior Ankle Impingement are individuals involved in gymnastics, ballet dancers, and individuals who play football.
Symptoms Of Posterior Ankle Impingement
Individuals with Posterior Ankle Impingement mostly experience the following symptoms:
- Acute pain at the back part of the ankle especially with activities that require excessive plantar flexion of the ankle like ballet dancing can be a symptom of posterior ankle impingement.
- Aching at the back part of the ankle even at rest after doing activities which aggravate the condition like kicking a football, running down a hill, and jumping.
Treatment Options For Posterior Ankle Impingement
The treatment for Posterior Ankle Impingement is mainly conservative but surgery is sometimes necessary, especially if the condition is caused by the presence of OS Trigonum and is not correctable with conservative treatments alone. The treatment for Posterior Ankle Impingement usually consists of five stages. All of these stages have been delineated in detail below.
Stage I: This stage involves relieving of pain and decreasing swelling caused due to Posterior Ankle Impingement. For the pain and inflammation to calm down and for reducing swelling, the patient will be requested to completely rest the affected foot and to avoid any aggravating activities. The patient will also be advised to ice the affected area for 15-20 minutes two to three times a day by either wrapping ice cubes in a towel or by using icepacks. This needs to be done until the swelling and pain resolves. This will be followed by compression of the affected area. For this, a compression bandage is good enough to support the injured soft tissues structures and calm down the swelling.
Elevation is the next step in which the ankle needs to be elevated above the level of the heart to reduce swelling caused due to Posterior Ankle Impingement. The patient will also be given NSAIDs in the form of ibuprofen and Motrin for pain relief.
Stage II: In this stage of treatment for Posterior Ankle Impingement, the patient is sent to the physical therapist for restoration of ankle range of motion. Depending on the level of injury, the physical therapist will formulate a detailed exercise regimen best suited for the patient.
Stage III: This stage involves restoration of strength of the ankle so that the patient can put weight on it without any discomfort. This will require aggressive strengthening exercises which will be designed by the physical therapist. Unless and until full strength and function of the ankle is back, it would not be possible for the patient to weight bear on the affected foot and ankle and walk for any distance without any discomfort.
Stage IV: Once strengthening exercises are started, the patient will be gradually brought to partial weightbearing status before going on to full weightbearing with crutches. If there is no discomfort and the patient is able to ambulate normally then the patient is allowed to discontinue the crutches and may start to walk normally. Once the patient is able to walk normally then the therapist will begin working on return to sport exercises. This will include working on speed, agility, and power. The physical therapist will focus on proprioception exercises to build strength in the ankle to allow the patient to return back to sports in the earliest possible time.
Stage V: This stage of treatment for posterior ankle impingement involves returning the patient back to normal activities including sports. This is usually done once the patient is able to do all agility, power, and exercises involving speed and can carry out activities like climbing stairs and running and jogging without any difficulties. Once the patient has been deemed as cured from Posterior Ankle Impingement by the physical therapist, the trainer may ask the patient to do certain sport specific exercises upon completion of which the patient will be gradually drafted back into competitive sport.
Surgery for Posterior Ankle Impingement: It is not common for an individual to have surgery for Posterior Ankle Impingement. However, there have been cases where an individual has undergone surgery to correct this condition. This is especially in those patients who have recurrent cases of Posterior Ankle Impingement and put excessive pressure on their feet like an extremely high level athlete.
The surgical procedure involves complete removal of any bone spurs or soft tissues through arthroscopic means or by making an incision and opening up the ankle. Generally those bone spurs are removed that are believed to be causing the impingement.
The surgical approach towards treatment of Posterior Ankle Impingement has its own risks especially in cases where the individual has significant arthritis and where the symptoms may get worse after surgery for Posterior Ankle Impingement.
Steroid Injections: Apart from the above mentioned treatments and surgical approaches, steroid injections may also be helpful in treatment of Posterior Ankle Impingement, especially if they are done early in the diagnosis. They work by calming down the inflammation and reducing pain and swelling. However, this treatment is not always given as steroid injections may not always be beneficial and has its own risks and complications.
Acupuncture: This is yet another form of treatment that can be beneficial for treatment of Posterior Ankle Impingement. A visit to an acupuncturist may be of value to see if an individual is a good candidate for acupuncture treatment of Posterior Ankle Impingement.