Anterior ankle conflict

The previous ankle conflict is a painful condition of the foot that mainly concerns athletes, including footballers.

Definition

Any abnormal contact between parts of the joint when it is in motion is called conflict. This conflict can be bone or soft parts of the ankle.

Pain can be caused by:

There are 3 types of ankle conflicts:

The anterior ankle conflict often appears following a relaxation of the lateral ligament. This relaxed ligament will lead to the appearance of an abnormal mobility that causes the joint to malfunction. This can lead to the formation of bony beaks or tissue conflicts and cause pain.

Causes and risk factors

Previous conflict is a condition particularly present in athletes. It is often the result of repeated sprains or strain injuries. The latter will then create a painful scar and bony beaks (or osteophytes) inside the ankle joint.

Sport is the main risk factor for this disease. Ball sports are particularly at risk since they require a lot of stress from the ankle in back flexion.

Symptoms of anterior ankle conflict

There are several symptoms of anterior ankle conflict:

The patient will often complain of pain whilst moving. Dorsal flexion movement is also limited or lost in some patients.

Diagnosing

To establish the diagnosis, the sports trauma specialist conducts a clinical examination of the foot. The location of the pain is the most evocative sign of the anterior ankle conflict. The latter is located on the front of the ankle and appears during activities.

Localized pain is also an indicator of the cause of the conflict. In the case of antero-lateral pain, the conflict is often tissue. Antero-internal pain is more like a bone conflict.

To confirm the diagnosis, Dr. Julien Lopez can prescribe a series of additional tests.

Specialized ultrasound

A specialized ultrasound allows the doctor to visualize tissues and detect tissue conflicts.

X-ray of the foot in charge

Radiography is used to analyze bone structure and detect bone conflicts. During the exam, the patient remains upright and carries all of his weight on the affected ankle. The shots are taken from the front and profile but also in AMI view mode.

Arthro-scanner

The arthro-scanner can be requested before the surgery to check the condition of the tissues and to make an accurate assessment of the lesions and cartilage.

Anterior ankle conflict: conservative treatment

In the case of anterior ankle conflict, conservative treatment is first-line of treatment. It is only indicated in certain cases. In the event of a bone lesion or bone beak in the joint, Dr. Julien Lopez will direct you to another treatment.

If all the necessary conditions are met, an infiltration of corticosteroids at the conflict level can be achieved. In case of previous ankle conflict, the anti-inflammatory effects of infiltration will help relieve pain. Corticosteroids are delivered into the joint using a needle.

This is done in a simple consultation. Infiltration definitely relieves 1 in 2 patients. If treatment fails, surgery is recommended.

Ankle arthroscopy for a previous conflict

Ankle arthroscopy for a prior conflict is the surgical reference technique.

In order to perform this procedure, the patient is placed on the back. The surgeon inserts a camera and miniaturized instruments into the joint through small holes. The image is displayed in real time on a screen to allow the surgeon to visually control the gestures made.

The goal of the surgery is to sever the blockers in order to suppress the pain and to return all mobility to the ankle.

The foot surgeon then performs a visual check to ensure that all necessary items have been removed. He’s also running a cartilage check.

The surgery is performed on an outpatient basis under local or general anaesthesia. The patient can return to his home on the same day.

Anterior ankle conflict: physiotherapy and post-surgery

In case of a previous ankle conflict, physiotherapy and other measures will have to be put in place.

Support and resumption of walking are allowed on the same day with wearing of the walking boot prescribed by your surgeon.

To reduce the risk of algodystrophy and complex pain syndrome, an analgesic treatment is prescribed to properly control pain.

The dressing must be redone every 2 days until complete healing.

In order to avoid the appearance of swelling, gestures must be implemented:

Self-rehabilitation is recommended for 2 to 3 months. In addition, physiotherapy sessions may also be prescribed.

Returning to work

The return to work may take place 2 to 6 weeks after the intervention. The delay varies depending on the surgical actions performed and the nature of the patient’s work (physical work…).

The resumption of driving may take place when the mobility of the ankle allows it. Lack of back flexion of the ankle can prevent driving during the first few weeks after the operation.

The resumption of normal walking and sports activities may take place between 1 and 3 months after the operation, depending on the surgical actions performed and the nature of the activity.

Possible complications

Like any surgery, complications can occur such as stiffness of the ankle joint, swelling, or persistent pain.