الفهرس 
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Abstract
The ankle impingement syndromes are an established cause of ankle
dysfunction within the general population and within the athletic community. It
can happen following a simple ankle sprain or repeated trauma. Can also be
caused by abnormal anatomy either bone or soft tissue. In many cases the
diagnosis is clinical, although imaging has a significant role to play particularly
in the exclusion of alternative or concomitant pathology or when the diagnosis
is in doubt. Ultrasound or simple x-ray can show the problem while some cases
need MRI to establish the diagnosis. For most patients conservative
management or nonsurgical intervention allows resumption of their previous
level of activity, even in elite athletes. Conservative treatment varies fr0111
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simple rest and anti-inflammatory drugs, periods of immobilization, and local
anesthetic and cortisone injections under ultrasound guidance.
Surgical treatment for more resistant cases has a low complication rate and a
high level of success. Both open and arthroscopic techniques are used with high
rate of success for open treatment of some types.
Rehabilitation after non surgical treatment includes some rehabilitation
exercises to regain ankle function. It is very important to improve strength and
coordination in the ankle.
After debridement surgery, patients are usually placed in an ankle splint.
Patients begin by using crutches. The amount weight bearing is gradually
increased over a period of one to two weeks. Patients generally advance quickly
in rehabilitation and are able to resume normal activity within tour to six weeks.
7?
./’ Soft tissue and osseous impingement syndromes are new increasingly
recognized as a significant cause of chronic ankle pain which leads to
disability.
./’ Impingement is a painful mechanical limitation of full ankle movement
2ry to osseous or soft tissue abnormality.
./’ Classification of the ankle impingement syndromes is anatomic according
to their relationship to the tibiotalar joint. Each anatomic site may have
similar injury etiology, but presents with differing’l1linical signs and
symptoms and imaging findings.
./’ Anterior impingement is a relatively common, seen particularly in such
athletes as ballet dancers and soccer players, symptoms are caused by
impingement of hypertrophied soft tissue and bony spurs within the
anterior ankle joint. Symptoms are pain with dorsiflexion with or without
swelling and stiffness.
./’ Anterolateral impingement are caused by trauma causing hemorrhage
inside the anterolateral recess or by abnormal distal anteroinferior
tibiofibular ligaments, symptoms is pain in the anterolateral joint line
with weight bearing increased by finger in the joint line and dorsiflexion
and eversion. ’ ~
./’ Anteromedial impingement is to be a sequel of repeated trauma and
healing following the original inversion injury that initiates tissue
thickening within the anteromedial compartment that can become
compressed during dorsiflexion and inversion. Symptoms are pain with
these movements.
./’ Posterior impingement is caused by Steida process or os trigonum or soft
tissue impingement, or the presence or abnormal posterior intermalleolar
ligament. Symptoms are pain with plantarflexion’ o!with or without
swelling.
./ Diagnosis is mostly clinical, or x-ay in case of bony exostoses or by MRI
in case of soft tissue pathology.
./ General treatment is rest, immobilizations or nonsteroidal injections.
./ If no response, excisions by arthroscope usually are successful.