Ankle Lateral Gutter

Impingement after tar can be a source of pain and decreased patient satisfaction which in turn results in poor outcomes 1impingement is of an unknown complex etiology and is likely multifactorial. 3 during an inversion ankle injury the anterior talofibular ligament and calcaneofibular ligament are affected as is the distal syndesmosis. However inadequate immobilization and rehabilitation may lead to chronic inflammation in the ligament resulting in formation of scar tissue.

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3 over time a meniscoid lesion is often the result of the lateral ankle injury.

Ankle lateral gutter.

The ligamentous injury is not severe enough to cause chronic instability. It is an uncommon cause of chronic lateral ankle pain 6 typically seen in athletes 3 5. The anterolateral ankle gutter is the most common site of ankle impingement. The lateral gutter of the ankle joint can be found by running the thumb medially over the anterior and medial edge of the fibula.

Medial and lateral gutter ankle impingement may result after total ankle replacement tar. Patients will complain of pain around the anterolateral ankle gutter during weightbearing and may feel like the pain is deep in the joint. The investigators noted that if hypertrophic synovitis is present this maneuver impinges the synovium between the neck of the talus and the distal tibia. Anterolateral ankle impingement has been known under the term anterolateral meniscoid lesion which is the result of synovitis in the anterolateral gutter.

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. The lateral shoulder of the talus can be felt at the joint line by dorsiflexing and plantar flexing the ankle. Anterolateral impingement syndrome of the ankle is caused by entrapment of the hypertrophic soft tissue in the lateral gutter. The impingement process begins when an inversion sprain tears the anterior talofibular and or the calcaneofibular ligament.

The distal syndesmosis is felt by following the medial edge of the fibula superior to the joint line.

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