Repetitive micro injuries can lead to the formation of scar tissue and “tractions spurs” at the front of the ankle which is called a footballer’s ankle. The inflamed tissue can get caught between the two bones of the ankle and bony prominences will increase the risk of the impingement. When the ankle is mobilised upwards like in the squatting position pain is most likely to occur at the front of the ankle whereas if the joint is pointing downwards the pain can be felt at the back of the ankle. This is called posterior impingement and can be linked to an “additional” bone called os trigonum.
Sometimes bony spurs are signs of early stage arthritis of the ankle joint but treatment is very different to degeneration of the entire ankle joint.
Conservative treatment should be initiated and one should avoid any movements that cause the pain but often this is not possible especially for sports people. In case of persistent pain, surgery is the only option to remove the underlying cause of the impingement. Keyhole surgery (arthroscopy) to the front or back of the ankle joint allows taking away any scar tissue, bony spurs, excessive soft tissue and inflamed tissue. At the same time, one can also take care of any other problem inside the ankle joint if needed. Recovery after an arthroscopy depends on various factors but is faster than after an open procedure. The outcome after “debridement” of the ankle joint is very satisfactory and patients are normally able to resume their sports activities within a reasonable time.