Anterior Ankle Impingement Diagnosis | Signs & Symptoms

Anterior Ankle impingement is a condition involving synovial hypertrophy, cartilage proliferation, scar tissue formation, calcification, and or osteophyte formation in the anterolateral gutter. It’s a result of trauma, specifically dorsiflexion trauma, ankle inversion trauma, or repetitive stress. Most patients report a history of these traumas and report chronic anterolateral ankle pain and or limited dorsiflexion.

Liu et al. (1997) wondered whether there were any findings from patient history and physical examination that could aid in the non-invasive diagnosis of ankle impingement.
Their retrospective analysis of 22 patient cases revealed a sensitivity of 94% and specificity of 75% for 5 out of 6 positive findings. When interpreting these findings, the big confidence intervals and overall study design result in only moderate clinical value.

The six findings you should look out for according to the authors are:

1. Anterolateral ankle joint tenderness
2. Anterolateral ankle joint swelling probably due to synovitis
3. Pain with forced dorsiflexion and eversion of the affected ankle, which will narrow the anterolateral gutter
4. Pain with single-leg squat on the affected ankle
5. Pain with activities. These have not been described in detail in the study but think of tasks or activities requiring dorsiflexion (e.g. walking down stairs, squatting, and especially sports)
6. Absence of ankle instability, which you can assess with the anterior drawer test of the ankle.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Orthopedic tests to help your diagnosis of ankle impingement are:

• Forced Dorsiflexion Sign (Anterior Impingement)
• Heel Thrust Test (Posterior Impingement)

Liu, S. H., Nuccion, S. L., & Finerman, G. (1997). Diagnosis of anterolateral ankle impingement: comparison between magnetic resonance imaging and clinical examination. The American Journal of Sports Medicine, 25(3), 389-393.