Conservative
Relative activity limitation such as avoiding jumps, avoiding forcing of demi-plié, combined with attention to correct technique to reduce pronation may improve the symptoms of anterior impingement in dancers.
Physical therapy with focus on the entire kinetic chain, joint mobilization, and taping may resolve symptoms in some dancers.
Use of a night splint or removable walking cast brace can be tried briefly, and a single intra-articular corticosteroid injection may be used in select cases when other conservative measures prove ineffective.
Operative
Ankle arthroscopy is a useful tool both for diagnosis and treatment of persistent ankle pain following injury and it may be the only way to definitely diagnose and treat soft tissue impingement from an abnormal fibrous band [
13[k4]]. Arthroscopy also provides highly effective treatment of bony and anterior soft tissue ankle impingement provided there is no significant associated chondral lesion in the anterior ankle [
9].
Surgical treatment is reserved for those dancers who have failed conservative measures. If initial radiographic studies fail to show osseous impingement, then an ankle arthroscopy is performed. Thickened synovial tissue, and or the thickened distal fascicle of the anteroinferior tibiofibular ligament is debrided with a shaver. Any articular cartilage damage is addressed with debridement, drilling, and/or microfracture.
For those dancers with osseous impingement, either talar neck or tibial, arthroscopic or open ostectomy can be performed. Any hypertrophied tissue is debrided along with the osteophytes. Open treatment is not recommended when an osteochondral defect is present, but for talar neck or distal tibial osteophytes without other intra-articular pathology, a small anteromedial arthrotomy can be used effectively.
Post-operative care includes use of an ankle cryo-cuff to control edema and pain, alternating with a removable boot for ambulation. Patients are allowed to bear weight as pain allows unless an osteochondral defect has been drilled. In that case, patients are maintained strictly non-weightbearing for 6 weeks. After 10–14 days (for those with simple debridement or ostectomy), the patient is allowed to wean out of the boot. Physical therapy is begun to gradually increase range of motion and strength, with attention to proprioception exercises. Dancers may start Pilates, floor barre, and return to class gradually as comfort allows. Dancers are counseled that return to full performance may be limited for up to 6 months.