Ankle Impingement Syndrome and Prolotherapy
THE MORE DIAGNOSES ON AN MRI REPORT-- THE MORE A PERSON NEEDS PROLOTHERAPY
An Example of an Ankle MRI Report:
 Recently, a new client came into the office with a long history of ankle problems and had multiple findings on his MRI report. Here is what his report included:
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Inframalleolar tendinopathy
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Os tibiale stress reaction
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High-grade anterior superficial deltoid layer chronic sprain of
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anteriormedial ankle with impingement (this actually may be two or three diagnoses!)
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Mild anterior talofibular ligament sprain
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Mild calcaneofibular ligament sprain
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Low-grade posterolateral impingement
The major items that stand out in the above report are the various ligament sprains, stress reactions, and tendinopathy, which often mean a weakened or degenerative tendon. Stress reactions are commonly reported on MRI. To give you an example, stress reactions were found in 43% of 21 asymptomatic college distance runners and were not predictors of future stress reactions or stress fractures.1 So what do stress reactions mean? For college runners, stress reactions mean very little according to the above study. Stress reactions occur because of accelerated remodeling of the bone or periosteum (outside of the bone). They typically occur where tendons attach to bone and thus are a sign that the body is getting excessive pressure at the fibro-osseous junction or enthesis. I believe this is one reason why bone spurs occur at these areas. The body is trying to strengthen the area by overgrowing bone. What is the best treatment for this? Stop exercising? I don’t think so, it would be better to strengthen these fibro-osseous junctions (where tendons and ligaments attach to bone) with Prolotherapy, and then the athlete or person could exercise even more! So for the above client, stress reactions in these various areas are another sign that the person needs Prolotherapy!
Prolotherapy is the Best Alternative Treatment for Anterior or Posterior Ankle Impingement Syndrome:
I personally think surgery should only be utilized for pain after more conservative treatments have failed. So I typically wouldn’t recommend surgery for impingement syndromes in the ankle, hip, or shoulder unless the person first had a trial of Prolotherapy. Why? Because Prolotherapy typically resolves it (there are exceptions of course).
 Ankle impingement is described as ankle pain that occurs during athletic activity, with recurrent, extreme dorsiflexion or plantar flexion when the joint under load. It has various causes and thus the various names including osseous impingement, soft tissue impingement, impingement of the distal fascicle or anterior inferior tibiofibular ligament, and meniscoid lesions.2 The best treatment I have found for ankle impingement is Prolotherapy. I hope once you understand the causes of ankle impingement it will make sense as to why Prolotherapy is the best treatment option for long-term resolution.
Ankle impingement syndromes are sub classified according to the anatomical location about the tibiotalar joint, with the most common classifications being anterior and posterior ankle impingement syndromes. Both typically occur after trauma and cause chronic, progressive pain, swelling, and limitation of movement. Anterior impingement symptoms typically occur when the foot is forced upward with dorsiflexion and posterior impingement syndrome causes pain behind the heel or deep in the back of the ankle when the foot is pointed down with plantar flexion. On MRI or x-ray there are often bone spurs or anatomical variants associated with the impingement.
Typically folks who have ankle impingement syndrome give a history of ankle sprain or significant ankle injury. Therefore, it becomes clear that it is the injury that was ultimately the cause of the impingement. Associated with it may be some bony spurs or anatomical variants like os trigonum (stieda process). We all know also that bone spurs are the body’s response to stabilize an unstable structure. So bone spurs associated with impingement are telling the person and doctor that at some point ligaments about the ankle were injured and did not heal completely so the body developed a bone spur in an area to stabilize the area.
Traditional Treatments vs. Comprehensive Prolotherapy for Ankle Impingement
 Traditional treatments for ankle impingement syndrome involve immobilizing the ankle, ice, rest, NSAIDs, cortisone shots and ultimately surgery. While these treatments might provide some short-term relief, often the pain recurs. They typically do not provide long-lasting relief unless you continuously take the NSAIDs and significantly limit activity. Unfortunately, this approach just causes progressively further restriction of ankle motion.
The patient above needs Comprehensive Prolotherapy to all or most of the ligament structures around the ankle to stimulate the repair of those tissues. This means that both the front and the back of the ankle need to be treated. Along with this, an exercise program that involves ankle motion, including cycling and swimming or kicking in the pool, would be needed. To help improve proprioception (balance) single leg standing and balance exercises would also be recommended. By strengthening the ligaments and structures involved with ankle stability over time, Prolotherapy will typically resolve the pain associated with ankle impingement syndrome. Typically four to seven visits for this condition are needed.
Conclusion:
If you or a loved one receives an MRI report with more than one diagnosis there is a good chance you are a Prolotherapy candidate. If your pain does not resolve, whether it is in the ankle or another part of your body, consider using Prolotherapy to resolve your pain. Give us a call today to set up an appointment.
1Bergman AG, Fredericson M. Asymptomatic tibial stress reactions: MRI detection and clinical follow-up in distance runners. American Journal of Radiology. 2004;183:635-638.
2Hess GW. Ankle impingement syndromes: a review of etiology and related implications. Foot and Ankle Specialty. 2011;4:290-297.
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