Anteromedial impingement of the ankle is one of the ankle impingement syndromes and can occur as a late effect of a traumatic injury 1-3.
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Epidemiology
It is one of the less common ankle impingement syndromes 2. It can occur as a result of a previous plantar flexion and inversion injury and can be seen in football players, cross-county runners and dancers 1.
Clinical presentation
Usually, patients complain of pain or clicking associated with dorsiflexion and inversion 1-3.
Pathology
Anteromedial ankle impingement can occur as a consequence of anterior tibiotalar ligament injury with subsequent synovitis, osteophyte formation from repetitive microtrauma, fractures and/or chronic ankle instability causing mechanical entrapment of the anteromedial part of the tibiotalar joint capsule 1-4.
Radiographic features
Plain radiograph/CT
Bony proliferation and osteophytic spurs can be seen at the anteromedial tibial plafond and at the medial malleolus 1, which can be better seen on lateral ankle radiograph or sagittal view on CT.
US
Synovial lesions and premalleolar hyperemia on color Doppler 3.
MRI
Soft tissue thickening can be seen at the anteromedial aspect of the tibiotalar joint with signs of synovitis and osteophyte formation 1. Possible associated bone marrow edema in the medial malleolus and medial talus.
Treatment and prognosis
Conservative treatment seems to be controversial, and definitive treatment is usually surgical or arthroscopically 1.
Differential diagnosis
- anterior ankle impingement
- osteoarthritis of the ankle: loss of joint space, subchondral cysts
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