douleur de cheville et syndrome du carrefour postérieur

Posterior ankle impingement

 

Causes and mechanism of injury

Posterior ankle impingement refers to the compression of the tissue and bones in the back of the ankle joint when the foot is flexed. issue can become pinched between the tibia and the calcaneusHeel bone. which causes pain. Posterior ankle impingement is also referred to as “dancer’s heel”.


Two mechanisms are known:

  • Posterior ankle impingement can occur as a result of a traumatic event such as an ankle sprain. In this scenario, the ligament does not heal properly. The scar may be too large and bulge into the joint and/or part of the joint capsule may remain inflamed and painful. In other cases, a bone spur or bone fragment can block the space just behind the ankle bones and cause problems.

  • Repeated microtrauma (e.g. types of dance that involve repeatedly being on the tips of the toes, kicking the ball when playing football, jobs that involve repeatedly pressing down on a pedal with the tips of the toes, etc.) can also cause posterior ankle impingement.

 

 

Symptoms

Posterior ankle impingement manifests as cracking and pain when the ankle is in plantar flexion. The pain is sometimes clearly felt at the back of the ankle but most often the pain is too deep for the precise location to be determined.

The pain can arise when playing sports, dancing, driving or even simply going down the stairs. It is usually felt instantly when the ankle is plantarflexed but can occasionally have a delayed onset.

One or a combination of various imaging techniques can be used to diagnose posterior ankle impingement:

  • Non-weight-bearing X-rays
  • Magnetic resonance imaging (MRI)
  • CT scan without contrast and/or CT arthrogram
  • Bone scan (also known as bone scintigraphy)

  • If the diagnosis cannot be confirmed, a steroid injection may be administered into the back of the ankle to see if this helps ease the pain. Relieving the pain helps confirm the diagnosis and can sometimes treat the cause.

 

 

Treatment of posterior ankle impingement

First-line treatment

The recommend first-line treatment for this condition consists of various non-surgical measures:

  • Oral pain medication and anti-inflammatories
  • CryotherapyCold therapy.
  • StrappingThe aim is to limit the plantar flexion of the foot.
  • Immobilisation, or even non-weight-bearingAvoiding putting weight on the foot by using crutches. if the pain is severe
  • Massage and rehabilitation through physiotherapy
  • X-ray- or ultrasound-guided steroid injectionA procedure that is both diagnostic and therapeutic – see previous section.

If these measures fail or only partly work, surgery may be considered as second-line treatment.

Second-line treatment

Posterior ankle impingement surgery involves treating the parts of the ankle joint that are causing the pain and is performed under loco-regionalNumbs only the limb being operated on., general or spinalNumbs the body from the waist down. anaesthetic. The type of anaesthetic that will be used in your procedure will be decided with the anaesthetist during your preoperative assessment.

This surgery is usually performed with the help of an arthroscope. Two small incisions are made on either side of the Achilles tendon. A tiny camera is then inserted into the ankle through the first incision and surgical tools used to carry out the various therapeutic procedures are inserted through the second. Once the posterior ankle impingement has been treated, the incisions are closed and a dressing is applied.

 

 

FAQs

What does this operation aim to achieve? The aim of this operation is to reduce or even eradicate the pain by removing the source of the impingement.

Can the operation be done as an outpatient procedure? Yes, provided that you have friends or family who can help you.

Is the operation painful? The majority of patients experience a moderate level of pain which is able to be managed by the pain medication prescribed.

Will I be able to walk after the operation? Yes, but you will have to use crutches for 10 to 15 days.

Will immobilization be necessary? No, you will not need a cast or a splint.

What kind of aftercare is provided? Your dressings will be tended to every other day by a nurse and physiotherapy sessions will be arranged to aid your rehabilitation.

When can I resume my day-to-day activities? ou will be able to resume your day-to-day activities a few days to a few weeks after your operation. Sports activities may be allowed to be resumed after a few weeks to a few months depending on the sportfor example, cycling and swimming after three weeks, running after two months..