Medial and lateral gutter ankle impingement may result after total ankle replacement tar.
Ankle lateral gutter.
The investigators noted that if hypertrophic synovitis is present this maneuver impinges the synovium between the neck of the talus and the distal tibia.
It is an uncommon cause of chronic lateral ankle pain 6 typically seen in athletes 3 5.
3 during an inversion ankle injury the anterior talofibular ligament and calcaneofibular ligament are affected as is the distal syndesmosis.
Anterolateral impingement syndrome of the ankle is caused by entrapment of the hypertrophic soft tissue in the lateral gutter.
The lateral shoulder of the talus can be felt at the joint line by dorsiflexing and plantar flexing the ankle.
The distal syndesmosis is felt by following the medial edge of the fibula superior to the joint line.
The impingement process begins when an inversion sprain tears the anterior talofibular and or the calcaneofibular ligament.
However inadequate immobilization and rehabilitation may lead to chronic inflammation in the ligament resulting in formation of scar tissue.
The ankle impingement sign described by malloy uses thumb pressure over the lateral gutter while taking the ankle from a plantar flexed position to maximal dorsiflexion.
Patients will complain of pain around the anterolateral ankle gutter during weightbearing and may feel like the pain is deep in the joint.
The lateral gutter of the ankle joint can be found by running the thumb medially over the anterior and medial edge of the fibula.
The ligamentous injury is not severe enough to cause chronic instability.
3 over time a meniscoid lesion is often the result of the lateral ankle injury.