Niek van Dijk C
Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DD Amsterdam, The Netherlands.
Foot Ankle Clin. 2006 Sep;11(3):663-83. doi: 10.1016/j.fcl.2006.06.003.
Anterior ankle impingement is characterized by anterior ankle pain on activity. Recurrent (hyper) dorsiflexion is often the cause. Typically, there is pain on palpation at the anteromedial or anterolateral joint line. Some swelling or limitation in dorsiflexion are present. Plain radiographs can disclose the cause of the impingement. In the case of spurs or osteophytes, the diagnosis is anterior bony impingement. In the absence of spurs or osteophytes, the diagnosis is anterior soft tissue impingement. In patients with anteromedial impingement, plain radiographs ae often falsely negative. An oblique view (anteromedial impingement view = AMI view) is recommended in these patients. Arthroscopic management with removal of the offending tissue provides good to excellent long-term (5-8 years) results in 83% of patients with grade 0 and grade I lesions. Long-term results are good/excellent in 50% of patients with grade II lesions (osteophytes secondary to arthritis with joint space narrowing). In posterior ankle impingement, patients experience hindfoot pain when the ankle is forcedly plantarflexed. Trauma or overuse can be the cause. The trauma mechanism is hyperplantarflexion or a combined inversion plantarflexion injury. Overuse injuries typically occur in ballet dancers and downhill runners, who report pain on palpation at the posterolateral aspect of the talus. On plain radiographs, an os trigonum or hypertrophic posterior or talar process can be detected. Surgical management involves removal of the os trigonum, scar tissue, or hypertrophic posterior talar process. In the case of combined posterior bony impingement and flexor hallucis longus tendinopathy, a release of the flexor hallucis longus is performed simultaneously. Endoscopic management is associated with a low morbidity, a short recovery time, and provides good/excellent results at 2-5 years follow-up in 80% of patients.
踝关节前部撞击症的特点是活动时踝关节前部疼痛。反复（过度）背屈通常是病因。典型表现为在内侧或外侧关节线处触诊时有疼痛。存在一些肿胀或背屈受限。X线平片可揭示撞击的原因。如果有骨赘或骨质增生，则诊断为前部骨性撞击症。若无骨赘或骨质增生，则诊断为前部软组织撞击症。对于内侧撞击症患者，X线平片常呈假阴性。这些患者建议拍摄斜位片（内侧撞击症视图=AMI视图）。关节镜下切除病变组织，对于0级和I级病变患者，83%可获得良好至极佳的长期（5 - 8年）效果。对于II级病变（继发于关节炎且关节间隙变窄的骨质增生）患者，50%可获得良好/极佳的长期效果。在踝关节后部撞击症中，当踝关节被迫跖屈时患者会感到后足疼痛。创伤或过度使用可能是病因。创伤机制为过度跖屈或内翻跖屈联合损伤。过度使用损伤通常发生在芭蕾舞演员和下坡跑者身上，他们在距骨后外侧触诊时会感到疼痛。在X线平片上，可检测到三角骨或肥厚的后踝或距骨突。手术治疗包括切除三角骨、瘢痕组织或肥厚的距骨后突。如果合并后部骨性撞击症和拇长屈肌腱病，则同时进行拇长屈肌松解术。内镜治疗发病率低、恢复时间短，在80%的患者中，随访2 - 5年可获得良好/极佳的效果。
