pathology: subfibular impingement

yogabook / pathology / subfibular impingement

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Definition

Subfibular impingement is a bony external impingement of the plantarflexing fibula tendons ( fibularis longus and fibularis brevis , as well as possible other plantarflexing fibularis varieties). It mainly occurs in fallen arches and flat feet , as calcaneus valgus or hindfoot valgus significantly narrows the space between the fibula and calcaneus . Other possible causes are exostoses or other bony changes in one of the two bones. This is therefore not another form of ankle joint impingement , since in these the impingement occurs between the talus and calcaneus , i.e. in the ankle joint . Subfibular impingement , on the other hand, is a pronator subtalar impingement . Since the range of motion in the direction of supination is much larger than in the direction of pronation , a supinatory subtalar impingement does not occur in practice and certainly not in everyday movements. Dorsiflexion of the foot and the rolling of the foot during the gait cycle can be painful, especially since the The fibular group must contract intensively during the rolling process, causing the muscles to change length and the tendon to move under the malleolus lateral . Accompanying symptoms of a subfibular impingement can be cystic changes, subchondral bone marrow edema , sclerosis, and damage to the fibular tendons. In cases of subfibular impingement is normally , the calcaneus so markedly valgus that the triceps surae has reversed its supinator function to a pronator function (reversal of the function of the triceps surae in this dimension of movement). This results in adversely altered kinetics of walking , and especially running, with corresponding risks. As part of the kinetic chain, the plantar fascia can also be affected, and sinus tarsi syndrome can occur. These disorders are not caused by the subfibular impingement , however , but by the underlying disorder of the calcaneus . A lateral talocalcaneal impingement ( OSG impingement ​ subfibular impingement . ) may accompany

Causes

  1. PTTD
  2. Flat feet
  3. Flat feet
  4. Exostosen
  5. malhealed calcaneus fractures ​
  6. Arthritiden

Predisposing

  1. Age and duration of the valgus position of the calcaneus

Diagnose

  1. clinical
  2. I am
  3. MRT

Symptoms

  1. Pain on movement, secondary pain on exertion below the malleolus lateral
  2. painful rolling of the foot
  3. painful dorsiflexion of the foot
  4. possibly painfully limited walking distance

Complications

  1. Rupture of fibular tendons

therapy

  1. Only if conservative therapy fails surgically

DD

  1. Sinus like syndrome