Has anyone know how to treat this ankle problem?

[wkyagnes]

Hi! I am new in here. I would like to ask some advices on the problem called anteroinferior tibiofibular ligament impingement ( Basset's ligament) for an ankle pain patient.
Does anyone heard about this before? I graduated a few years now, but i haven't heard about this name in my study. Any idea of the treatment plan? Bcos I suggest one of my ballet dancer suffers from this type of problem.
My dancer sprained her ankle a few days ago. There was no obvious swelling but active inversion was painful and palpation on ATFL was slightly tender.
She was responding well with the treatment including US, IFT, TFM, Ice and wobble board training. She felt a lot better within a few days but she still complains of a catching pain when she did the pile movement. Any idea of to share?
Thank you

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[physioz]

I think this ligament is a distal fascicle of the anteroinferior tib-fib ligament and it is orientated parallel and distal to the anterior inferior tib-fib ligament. Co-existent instability in the ankle region can result in the lig causing antero-lateral impingement.

Not sure what movement you are talking about - would guess tib/fib external or internal rotation on a fixed (dorsiflexed) ankle may be problematic?

Try taping (possibly a circumferential 'syndesmosis type' method - difficult to tell withoutout knowing more about the injury), activity modification, possibly later corticosteroid jab and very very very last resort arthroscopic Sx (Oops! Nickhedonia will kill me if I don't mention unilateral spinal mobs)

cheers

physioz

[nickhedonia]

numb with joy I am Physioz. Not sure wether i should be glad you have mentioned the obvious , or suitably impressed with your straightforward consideration of the young dancers "sprain". In any case it doesn't sound like a referred problem from the description and response to treatment. Could you elaborate on the taping method you proposed ?, sounds like a wise choice for a dancer keen to practice, better than rest if she copes with it.

[Physiobase]

All sounds on track. Catching anteriorly (or anterior impingement) might just be a common protective post injury due to overactivity of the achilles (via soleus) during the plie. This can often be reduced with AP mobs of the tibia on the talus. Give is a bit of time that's all and let her know it will take sometimes 6-8 weeks to restore full dorsiflexion during plie on that leg.

Can you confim whether she had an xray? or whether you have cleared the possibility of any small avulsion fracture of the distal fibula or any talar dome involvement? 8o

[PhysioBex]

Here's a totally anecdotal reply for you...

Seems very similar to the problem I have with my ankle after numerous large scale sprains. I have been diagnosed with a grade 3 instability of the ankle and resultant ongoing pain with dorsi-flexion is said to be caused by impingement over the talus. I found taping to be very effective. I found that if the taping reduced the anterior glide at my ankle joint (secondary to instability) then the impingement was no longer an issue. It took a LONG time to settle in my case but reducing the aggravation of re-impingement helped+++.

Hope this helps.

[PhysioFish]

Anterior lateral (quadrant) impingment of the ankle:
If pain is principally presenting in dorsiflexion /forced dorsiflexin, use posterior talar glides (talar rock) as part of therapy to restore mechanics: patient sits legs dangling over bed (knee bent 90), PT hands either side below maleoli, fingers around calaneus, thumbs on anterior talus; posterior glide on talus as rhythmically swings pt's foot and ankle backwards (thus flexing knee and dorsiflexing ankle). Also, need to look at the function of tibialis posterior, and factors affecting excessive pronation /inversion in weight-bearing.
If inversion /supination is the principal provoker, use Mulligan's MWM of posterior glide of distal fibula with pt's active supination /inversion, and Mulligan's taping technique.
In my opinion, the distal tib-fib joint is damaged in most "ankle sprains", therefore tape this with a simple circumferential tape at the malleoli.
If there is structural instability, that has to be placated before resolution of impingement issues can be achieved - not really any different from the shoulder or anywhere else.
Dynamic stability (in appropraite position) must be re-educated, even after a minor "sprain".