Ankle hurts, how long can you bear it?

As one of the important joints of the lower limbs, the ankle joint not only bears a very important load-bearing function of the human body, but also becomes the most complicated resultant force center in the process of human movement. Under heavy pressure, it can also ensure flexible activities, and the requirements for ankle joints are also very high. But if you get it, you have to pay, which is why the ankle is troubled by injuries.

Today we are going to talk about ankle joint impact syndrome, which is a painful state caused by the collision and extrusion of soft tissues or bones around the ankle joint under pressure during exercise. The main manifestations are chronic ankle pain and excessive activity. The main cause is cartilage injury caused by repeated micro-trauma, which leads to ligament and synovial hyperplasia and osteophyte. Synovial hyperplasia is embedded in osteophyte during joint activity, resulting in squeezing pain. Including bone impact and soft tissue impact, bone impact syndrome generally refers to the impact between talus and tibial osteophyte; Soft tissue impact is caused by hyperplasia and hypertrophy of joint capsule, synovium and ligament or scar tissue hyperplasia.

According to the different injury sites, ankle impingement syndrome can be divided into the following situations:

1, anterior lateral malleolus impact syndrome;

2. Anterior ankle impingement syndrome;

3. Anterior medial malleolus impingement syndrome;

4, medial malleolus impact syndrome;

5. Posterior medial malleolus impingement syndrome;

6. Posterior ankle impact syndrome. Then we will analyze them one by one.

Anterior lateral malleolus impingement syndrome

Ankle supination injury usually leads to tearing of anterior talofibular ligament, calcaneal ligament and anterolateral joint capsule with intra-articular bleeding, followed by hypertrophic scar tissue or synovium. It is often accompanied by cartilage erosion in the external front of talus and injury of posterior ligament and interosseous membrane of tibia and fibula. It should be differentiated from tarsal sinus syndrome. Imaging findings are abnormal soft tissue of lateral sulcus or/and abnormal hypertrophy of anterior tibiofibular ligament. Because the shape of inflammatory tissue under arthroscopy is similar to the meniscus of knee joint, it is also called "meniscus-like injury"

Anterior ankle impingement syndrome

Also known as football ankle, it is related to bone changes or soft tissue abnormalities of tibia and talus, usually bone impact. Due to frequent dorsiflexion, the anterior margin of the articular surface of the distal tibia repeatedly collides with the osteophyte of the upper margin of the talus neck, and sometimes synovial chondromatosis loose bodies accumulate in the anterior part of the articular capsule, which can also lead to anterior impingement syndrome. Radiological manifestations are mainly beak-shaped spurs formed on the anterior lower edge of tibia and the anterior upper edge of talus neck. This situation can also be divided into four degrees: degree I: synovial impact, X-ray film shows inflammatory reaction, bone spur size of 3 mm; ⅱ degree: osteochondral reactive osteophyte > 3 mm; ⅲ degree: severe exostosis with or without fracture, secondary osteophyte can be seen on the back of talus, often accompanied by osteophyte fracture; Ⅳ degree: Osteoarthritis changes of talus and tibia joint.

Anterior medial malleolus impingement syndrome

Meniscus injury or (and) abnormal thickening of anterior tibial ligament. It needs to be differentiated from accessory scaphoid injury.

Medial malleolus impingement syndrome

Ankle varus injury will lead to the impact of articular cartilage of medial malleolus and talus, osteophyte formation, tearing or squeezing of triangular ligament, local scar or hypertrophy of synovial tissue, and it will be embedded between the posterior edge of medial malleolus and the medial wall of talus when ankle flexion varus occurs, causing pain.

Posterior medial malleolus impingement syndrome

Imaging findings showed edema and thickening of tibialis talus tendon and flexor digitorum longus tendon, and osteophyte formation of medial malleolus and posterior medial talus.

Posterior ankle impingement syndrome

Associated with triangular sesamoid syndrome. Bone impact is common, such as talus posterior triangle injury, talus hyperplastic or calcaneal kyphosis. Soft tissue impact is characterized by tearing or hypertrophy of posterior ligament of tibia and fibula, transverse ligament and lower part of posterior ligament of ankle joint. It should be differentiated from posterior calcaneal osteoarthrosis. The imaging manifestations are the existence or injury of the posterior talus triangle, and the formation of osteophyte in the posterior talus process, which leads to the limitation of ankle plantar flexion, which may be accompanied by inflammation of flexor pollicis longus tendon sheath and inflammation and hyperplasia of adjacent synovium in different degrees.

Let's talk about triangular sesamoid syndrome first: the three common causes of posterior ankle pain are posterior bursitis, tendinitis longus and triangular bone syndrome. Triangular sesamoid syndrome (posterior talus triangle syndrome), also known as posterior malleolus impingement syndrome or talus compression syndrome, is one of the common causes of chronic recurrent pain in the posterior part of ankle joint. The posterior deltoid bone of talus is a common variation and the most common accessory bone of ankle joint, accounting for about 8. 1%, which is ossified by the independent ossification center of talus posterior process. Through cartilage connected with talus or completely separated, it can also appear as an independent irregular bone block. The triangular bone corresponds to the fibular fossa of the lateral tubercle of the posterior process of talus. Triangular bones can exist in pairs, or fuse with lateral tubercle to form a single process, or fuse with talus or form a joint. Triangular bone, like other accessory bones, can hinder the movement of the foot, and at the same time, it can be affected by external factors and lead to aseptic necrosis.

Etiology and pathological mechanism: it is more common in patients with frequent plantarflexion, such as ballet dancers, mountaineers and football players; Forced plantarflexion of the foot leads to the impact of the posterior lower edge of tibia or the upper edge of calcaneus; Injury of sesamoid triangle, posterior talus triangle, surrounding soft tissue and tendon (posterior malleolus impingement syndrome); The clinical manifestations are pain in the back of ankle joint and limited activity.

Imaging findings: both X-ray plain film and lateral film of ankle joint show that there is a triangular or elliptical posterior talus triangle behind talus. Some cases were accompanied by mild ankle osteoarthritis. Magnetic resonance imaging showed that there were edema signals in the posterior talus triangle and surrounding soft tissues, and the normal low-signal fiber connection between the posterior talus triangle and talus was interrupted, resulting in fluid signals.

MR manifestations: The triangular sesamoid or posterior triangular structure of talus is blurred and deformed, the signal of T 1WI is decreased, the signal of T2WI is increased, the peripheral fat edema, the signal of flexor digitorum longus tendon is increased, hydrocele can be seen, the morphological changes and abnormal signals of the bone structure of the posterior lower tibia and the upper margin of talus, and the triangular sesamoid and talus are degenerated.

Next, let's briefly talk about the means to treat ankle impingement syndrome:

0 1

conservative treatment

Conservative treatment? Conservative treatment methods can be considered in the early stage of the disease, including bed immobilization, physical therapy, systemic use of non-steroidal anti-inflammatory drugs, local joint cavity closure and other means. Conservative treatment can relieve the symptoms of swelling and pain in a short time. However, in the long-term effect, the treatment is not thorough, and it is easy to relapse and leave sequelae.

02

Arthroscopic treatment

Arthroscopic treatment of ankle impingement syndrome should first remove osteophytes and bone blocks, and at the same time deal with pain-causing factors such as debris after articular cartilage wear. Open surgical treatment can thoroughly find out the focus and remove the damaged tissue, but the operation is complicated and traumatic, and there is a risk of tendon, blood vessel and nerve injury during the operation, and it is easy to leave complications such as joint adhesion, scar and stiffness after the operation. Surgical treatment can be considered in the following situations: ① patients whose symptoms have not been relieved for 3 months after conservative treatment; ② Patients with a long course of disease that seriously affects their quality of life; ③ Patients with extremely severe local pain; ④ Patients with ankle joint loose body.

After the above long talk, it is estimated that everyone has a preliminary understanding of ankle impingement syndrome and its classification, and can even diagnose it by themselves. However, if you really have ankle discomfort, you should seek professional help in time.