Background
Anterior impingement is a common cause of pain in the ankle, especially in sportsmen. The primary symptom is anterior pain on dorsiflexion. The condition, first described by Morris and termed ‘footballers’ ankle’ by McMurray, is common in sports involving forced dorsiflexion of the ankle. Although the aetiology of the impingement lesion has not been elucidated clearly, the suspected mechanism is recurrent microtrauma from forced dorsiflexion leading to haemorrhage, scarring and the formation of new bone in the form of spurs at the anterior aspect of the ankle. Once formed, forced dorsiflexion of the ankle causes impingement between the spur and the neck of the talus. Successful open treatment of anterior impingement lesions has been reported previously.
Patients and methods
Open debridement was carried out for anterior impingement of the ankle in nine patients. Preoperative radiographs were used to group patients according to both the McDermott and the van Dijk scoring systems. The Ogilvie-Harris scoring system, a visual analogue scale of patient satisfaction, the time to return to full activity, and the ability to return to sports determined the clinical outcome. According to the van Dijk classification, no patients had grade 0 changes, eight had grade 1 changes and one had grade 2 changes. The patient with grade 2 changes corresponded to the patient in McDermott grade 4. This patient had established osteoarthritis of the ankle.
Results
At a mean follow-up of 2 years, according to Ogilvie-Harris, one had good and eight had unsatisfactory results preoperatively, whereas four had excellent, four had good, and one had unsatisfactory results postoperatively. The mean time to return to full activity was 14 weeks; five out of nine were able to play sports at the same level, and six out of nine were satisfied with the results. Most patients did not feel that the range of dorsiflexion returned to normal, but symptomatic relief allowed most to return to high-level sports.
Conclusion
It is concluded that open debridement for anterior ankle impingement is a safe and successful procedure.