What is anterior soft tissue impingement?

After an ankle sprain the damaged soft tissues on the front and outside of the ankle (the ligaments or the synovial tissue lining the joint capsule) will heal forming scar tissue.  In some cases, an excessive amount of scarring will develop on the synovium, and it gets pinched (impinged) between the bones of the joint. Likewise, if the ligaments become stretched due to a sprain, and do not re-tighten afterwards during healing, the slack ligament can get impinged in the joint.

What causes it?

A single serious sprain or repeated sprains will cause anterior soft tissue impingement.

How does it feel?

You will have chronic pain and swelling on the outside and front of the ankle which does not go away – even after following the correct rest and rehabilitation programme for a sprained ankle.  Your ankle may, or may not give way and feel unstable.

Diagnosis

Your doctor will ask you about your medical history, and he will make a physical examination of your foot and ankle, checking your movement and the location of the pain.  He will ask for X-rays to rule out osteochondral lesions.

Treatment – conservative

As this condition persists in spite of normal rehabilitation, surgery is the only treatment which will solve the problem.

Treatment – surgical

– Arthroscopic Debridement: your surgeon will make two small incisions over the area of impingement.  Through one he will insert a fibre-optic camera to look into the joint, and through the other, he will pass the surgical instruments. He will remove the inflamed and scarred synovial tissue, and he will trim or shrink the slack ligament so that it becomes tight again.  When he is sure that no soft tissue fragments remain, your surgeon will close the wounds.

Rehabilitation after surgery

You may need to wear an ankle brace and walk with crutches for the first few days, gradually increasing the weight on your foot.  After a week, you will begin physiotherapy exercises aimed at muscle strengthening, balance, and restoring a full range of movement. 

When will I be back to normal?

Office workers can return to work after a week, manual workers after 4 weeks, depending on their progress with physiotherapy.  You should be able to drive after 7 days, and should be able to start playing sport again after about 6 weeks, depending on your recovery.