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Dancers, footballers and all those involved in the sports are aware that injuries in the ankle joint, especially when there is no optimal healing of the bursal-connective elements, are the cause of a very painful condition in a region of the body that has a rich innervation. It is estimated that post-operative or post-injury scar tissue is formed in about 3% of all ankle injuries - because of it, an impingement of the soft tissues is observed. The soft tissue lesions include disruptions and dislocations of the peroneal tendons (tendonitis).
The impingement syndrome, as it is widely known, may also be attributed to overuse of the joint. If the pain is located on the posterior surface of the ankle during plantar flexion, then it we are talking about a posterior syndrome - it more frequently appears in dancers. Instead, if the pain is located on the anterior surface of the ankle, upon the plantar flexion, we are talking about an anterior impingement syndrome, also known as the “footballer’s ankle” or the “footballer’s foot”, as it is a lesion which mainly appears in the feet of the specific athletes.

Patients suffering from a posterior syndrome usually have an accessory bone, the os trigonum, which is seen in 7-10% of the adult population. Due to the limited available space between the tibia and the ankle, the soft tissues are “entrapped”, while the bone impacts on the tibia during the plantar flexion, namely during the movement of the instep away from the surface of the tibia, so that the foot tends to be aligned with the tibia - like a ballerina does, when dancing on the pointe shoes.

Contrariwise, the “footballers’ ankle” (anterior impingement syndrome) is mainly attributed to the growth of osteophytes, which are radiographically visualized as protrusions on the bones. Their formation is attributed to the recurrent injuries which “unravel” the joint capsule, a small sac containing fluid, which protects and lubricates the joint. As a consequence, a limitation in the area of ​​the ankle, an impingement and a trapping of the capsule between the tibia and the ankle, are observed, during the dorsiflexion, namely when the instep approaches the anterior surface of the tibia - such as when a footballer shoots a goal.

When, despite a proper conservative treatment (rest, physiotherapy, strengthening and restoration of the ankle stability), the pain persists for more than three months, then surgery is a preferred option. In the ankle, as well as in large joints, an arthroscopy is performed: In this bloodless, minimally invasive technique, a small camera (arthroscope) and special instruments are inserted into the joint through two or three small holes – in the past, incisions of 10 cm, or even 15 cm were required.
Nowadays, the surgical instruments have a small diameter, especially for the ankle joint, however, it is essential for the surgeon to have great experience and thorough knowledge of the area where numerous nerves, vessels and tendons are located. During surgery, depending on the cause of the lesion, the os trigonum, or the osteophytes and the pathological joint capsule, shall be removed.
Since there are no generalized osteoarthritic lesions, the return to sports activities takes place soon, even within 3-4 weeks.

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