X rays are often unremarkable but an mri or mr arthrogram may demonstrate the impingement.
Medial and lateral gutter ankle.
The lateral gutter of the ankle joint c can be found by running the thumb medially over the anterior and medial edge of the fibula.
The medial malleolus is the bony bit on the inside of the ankle.
Medial and lateral gutter ankle impingement may result after total ankle replacement tar.
The lateral shoulder of the talus can be felt at the joint line by dorsiflexing and plantar flexing the ankle.
The posterior edge of the distal tibia is sometimes referred to as the posterior malleolus.
Impingement after tar can be a source of pain and decreased patient satisfaction which in turn results in poor outcomes 1 impingement is of an unknown complex etiology and is likely multifactorial.
You will have specific point tenderness over the medial malleolus where the fracture is.
Ligamentous injury may also lead to instability of the joint but this is not always appreciated if there is no displacement.
A sports medicine physician can try to make this diagnosis by physical examination recreating the patient s symptoms by palpation of the area of inflammation and impingement.
The ankle joint represents the most commonly injured weight bearing joint.
Ankle impingement can hurt along the medial gutter as well white circle.
A history of a chronically unstable feeling that is manifested by recurrent injuries with pain tenderness and sometimes bruising over the medial and lateral ligaments is considered to indicate combined medial and lateral instability that is believed to result in rotational instability of the talus in the ankle mortise.
Indications for arthroscopic intervention of the medial or lateral gutter impingement include a minimum of 90 days preferably 6 months status post total ankle replacement pain localized to either or both malleolar regions with weight bearing isolated pain with palpation of the medial and or lateral gutters and radiographic evidence standing x ray or ct scan of prosthesis malleolar or prosthesis hypertrophic boney contact fig.
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.
It causes pain on the inside of the ankle which is exacerbated by activity especially running and jumping activities.
Fractures of the medial or lateral malleoli can lead to ankle joint instability and loss of normal ankle joint alignment.
