Has anyone had an ankle arthroscopy for impingement? My OS wants to do it because he thinks I have anteriolateral impingement. He wants to go in there and clean up some loose fragments, check out the ligaments, and free up the impingement. My pain is basically between the lateral talar dome and the fibula. I am wondering if anyone has had this procedure and what your experience was like. Thank you.
Hi,
It’s been a while. Has this relsoved itself or did you have surgery or other procedure. I’m facing anterior ankle impingement.
I did have this surgery done about 2 1/2 years ago. Recovery was hard because I wanted to be riding/running, but well worth it in the long run. The only issues I’ve had since were frequent MINOR sprains due to rolling the ankle before I had properly strengthened it. This year I’ve been running 50-70 mpw with zero issues.
Thanks for reply. If you don’t mind… what exactly was done? Was it bone spurs or trimming the ligament? Any info would be appreciated.
Yotoma
I ended up having an anterior ankle scope. Just to clean out the joint between the tibia and talus. I recovered from that but I still had the same exact pain. Well, I saw another Orthopod who said well that makes sense bc the problem is between your calcaneus and talus, basically the joint beneath the talus and tibia. Long story short, I had yet another scope and this time I know it worked because I no longer have that pain associated w the impingement and the pics during the scope showed a lot of scar tissue and fibrotic synovial tissue. I’m glad I did it but wish i had the right scope a year ago and wish that it was diagnosed correctly and that I was more informed… Recovery has been quick
Kelly,
good to hear recovery has been quick. Are you as sure-footed and confident in pushing/applying dynamic and hard force in all possible situations, i.e. bike hard climbing and sprinting, and running hard on uneven and varied surfaces?
I have similar concerns that there may be misdiagnosis, and want to get it right the first time. What, if any, imagining helped in finally identifying exact issue? MRI, Bone scan, xray, CAT scan, physical exam?
Did you have any particular pain indicators, i.e. heel walk, dorsiflexion lunge, ROM test, squeeze test, other? Did they have to scope to find the issue?
Was it probably caused by a sprain that formed syndesmosis ligament scaring? Was there no bone spurs involved?
Any other cautions or advice when dealing with the podiatrists and surgeons? I find that they have preconcieved notions on what is needed. They also don’t understand how important returning to triathlon at a high personal level is.
Any literature out there that you recommend?
Many thanks,
Mark
So - did you really have a subtalar joint arthroscopy?
I did and I swear I have a new ankle!! Is it rare??? After dealing with this impingement for 1 year I have never felt better. Ankle flexibility , motion, and push off is amazing
Damn…and you had some pretty good results with the bum ankle! I bet you’re looking forward to racing on two good ones!
Yes - not too many docs who do subtalar joint arthroscopy. Unusual and technical.
Ha yes, I did Ironman Idaho off running 1 maybe 2 days a week, and the result was a pretty painful race! Hopefully the next one will be better!
I thought it was unusual , That’s what my doc said. So far it has been my cure.
By the way, thanks Rroof for all your feedback. You’ve helped me a lot over the years 
Glad you are here…
Are you still gonna stay split between tri and running?
I think I’ll hit the running scene next year. Triathlon is just way tooooooo expensive for me! and time consuming, with school, work , and social life. I don’t know how you all do it year in and year out!!!
What is the most common for anterior impingement syndrome? Does it usually involve the AIFL with pain upon dorsiflexion?
I’ve been having symptoms for about 5 months and have been advised by a podiatrist to get inserts for my shoes. It doesn’t make sense as the pain is not going away regardless of NSAIDS, ice, rest, immobilization. Do I need to see a artho surgeon?
What good diagnosis methods can be used short of going in? I want some more clarity and certainty on exactly what is wrong before going in with the scope. Is this advisable?
Can be diagnosed by MRI by a good musculoskeletal radiologist or occasionally via “live” ultrasound. Have a diagnostic/therapeutic ankle block yet? As for whom to perform - whoever has done lots.
Hi, I’m with Kaiser, so I get what I can get. Forgive me, but when I had MRIs evaluated before, the most one would get is a 30 second review. Even had someone else evaluate and conclusions were indeterminate.
What is involved with “live” ultrasound? Is it commonly used and understood? I’ll check with the podiatrist I’m assigned to. (Not really a podiatrist as he really is just the prescriber of custom orthodics - nearly all his patients get them).
Is it the ortho surgeon that does the blocks?
I’m not wanting to turn whatever ligament into mush by continuing exercise, so it’d probably be better to be a bit more aggressive in getting some resolution now in the off season.
How accurate can diagnosis be in the absence of scoping? I’d want the doctor to have a high level of certainty of what the issue is before entry. I’ve heard that some times they find what they think is the problem, then cut. Only post operation does the patient find that still the same pain and they have to go in again at a different location.
Any valuable resources out there for patients to get educated? I’ve googled, but a lot of very technical, non-sport specific clinical studies that I can’t make sense of. Thank you for your insights.
rroof, I have been following a few posts over the last five months about ankle sprains and injuries and you seem to be the man with great advice and information. Not to hijack this thread, but today my doctor informed me that I have Osteochondral lesion of the talus. Was wondering if the injury being discussed on this thread is the same thing. I have never heard of it before and really need information if you can shoot me some links, I would greatly appreciate it. Thank you
No, OCD (osteochondral defect, not that OCD) 
are different than anterior impingement syndrome. The top of the talus is the bottom of your ankle “joint” and subject to compression and shear forces. A defect (seen on MRI usually, occasionally on x-ray) is usually a thin/wafer shaped loss of cartilage on the lateral side or a deeper/cup shaped lesion on the medial aspect. Basically a focal loss of cartilage in the joint.
Here are few photos to show you (have them handy since I just finished something recently with a patient). You can google “Berndt and Hardy Classification” as this describes the different types of lesions and treatment options.
Hi, I’m with Kaiser, so I get what I can get. Forgive me, but when I had MRIs evaluated before, the most one would get is a 30 second review. Even had someone else evaluate and conclusions were indeterminate.
What is involved with “live” ultrasound? Is it commonly used and understood? I’ll check with the podiatrist I’m assigned to. (Not really a podiatrist as he really is just the prescriber of custom orthodics - nearly all his patients get them).
Is it the ortho surgeon that does the blocks?
I’m not wanting to turn whatever ligament into mush by continuing exercise, so it’d probably be better to be a bit more aggressive in getting some resolution now in the off season.
How accurate can diagnosis be in the absence of scoping? I’d want the doctor to have a high level of certainty of what the issue is before entry. I’ve heard that some times they find what they think is the problem, then cut. Only post operation does the patient find that still the same pain and they have to go in again at a different location.
Any valuable resources out there for patients to get educated? I’ve googled, but a lot of very technical, non-sport specific clinical studies that I can’t make sense of. Thank you for your insights.
You are asking all the right questions. Ultrasound can be a great diagnostic tool, but it is extremely operator dependent and you won’t likely find the same person through a managed care like Kaiser to do this (i.e. the operating surgeon and ultrasonographer in one).
The “diagnostic” scope has value, but no one wants surgery unless needed, but therein lies your dilemma.