Soccer players with posterior ankle impingement can return to athletic activity rapidly with the use of a sonographically guided injection of steroid and anesthetic, according to a recent study conducted at Leeds Teaching Hospitals in Leeds, UK.
The study consisted of ten professional soccer players, between the ages of 22-30, with no previous posterior ankle pain who underwent MRI and sonographically guided injection for clinical posterior impingement. According to the study, despite rehabilitation with resolution of anterior and lateral symptoms after an initial inversion injury, all players developed posterior pain that was resistant to conservative therapy 3-4 weeks after the precipitating injury. The pain limited the athletes' ability to sprint and strike the soccer ball and prevented them from returning to competition.
"In our practice, we see many professional athletes with this condition and we found that the majority of them were showing excellent response to this treatment," said Philip Robinson, MD, and lead author of the study. "We decided to analyze the imaging features and injection results more rigorously for publication."
All players underwent MRI of the ankle after clinical examination by a foot and ankle surgeon. Sonographically guided injection was then performed into the posterior capsule abnormality. Posterolateal capsule thickening and synovitis involving an intact posterior talofibular ligament (ligament located in the back of the foot) were present in all ten patients.
According to the study, all players tolerated the injection procedure with no immediate or delayed complications. All patients noted a marked decrease in symptoms and stiffness immediately after the injection of bupivacaine (anesthetic).
"For patients, the results of this study mean that they should have a faster recovery time and may not require arthroscopy. It also demonstrates that ankle impingement syndromes which appear predominately soft tissue based can respond to image guided injection treatment," said Dr. Robinson.
This study appears in the July issue of the American Journal of Roentgenology.