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Diagnosis and treatment of anterior ankle impingement: state of the art
  1. Pedro Diniz1,2,3,
  2. Duarte André Sousa4,
  3. Jorge Pablo Batista5,6,
  4. Nasef Abdelatif7,
  5. Helder Pereira8,9,10
  1. 1 Department of Orthopaedic Surgery, Hospital de Sant’Ana, Parede, Lisbon, Portugal
  2. 2 Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
  3. 3 Fisiogaspar, Lisbon, Portugal
  4. 4 Orthopaedic Department of Póvoa de Varzim, Vila do Conde Central Hospital, Vila do Conde, Portugal
  5. 5 Arthroscopy, Centro Artroscopico Jorge Batista SA, Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
  6. 6 Clinical Department, Club Atletico Boca Juniors, Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
  7. 7 Orthopedic Reconstructive Foot & Ankle Surgery Unit, As Salam International Teaching Hospital, Cairo, Egypt
  8. 8 Knee and Ankle Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal
  9. 9 Ripoll y De Prado Sports Clinic: FIFA Medical Centre of Excellence, Murcia-Madrid, Spain
  10. 10 University of Minho, ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
  1. Correspondence to Dr Helder Pereira, Knee and Ankle Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde EPE, 4490-421 Póvoa de Varzim, Portugal; helderduartepereira{at}


The aim of this paper is to discuss anterior ankle impingement (AAI) regarding diagnosis, interventions, techniques and future perspectives. AAI is a pain syndrome due to soft tissue or bony impingement. Impingement caused by soft tissues is frequently found in the anterolateral compartment of the ankle, whereas impingement caused by bony spurs is generally located in the anteromedial compartment. Typical complaints are chronic ankle pain, limited dorsiflexion and swelling. The most important feature is recognisable tenderness on palpation, which helps distinguish this condition from an osteochondral lesion, which is characterised with deep ankle pain. Although the diagnosis is mainly based on clinical assessment, imaging is helpful for differential diagnosis and preoperative planning. Standard X-rays, using anteroposterior, lateral and an anteromedial oblique view for detecting bony spurs, are sufficient to make the diagnosis. CT can be used to accurately assess the extent and size of a bony spur. MRI is useful to evaluate soft tissue lesions and exclude concomitant pathology, like osteochondral lesions or stress fractures. Conservative treatment is the first-line treatment. In cases where conservative treatment has been unsuccessful, surgery may be indicated. Arthroscopic debridement is considered the gold standard to treat AAI. Rehabilitation protocol includes full weight-bearing and exercises to stimulate active dorsiflexion-plantar flexion and avoid stiffness.

  • ankle
  • impingement
  • arthroscopy

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  • Contributors PD performed a literature systematic review and contributed to writing the final text. DAS performed separately a literature systematic review and also contributed to writing the final text. JPB has contributed with revisions and figures of the final text. NA has contributed with revisions in the text. JPB and NA have actively participated in organising the content. HP has organised the content of the text as well as the team for preparing the manuscript; wrote several parts of the text, participated in all revisions and contributed with original figures of the final text.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article

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