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Subfibular impingement

current concepts, imaging findings and management strategies

Kaplan, Jonathan R.M. MDa; Aiyer, Amiethab MDb; Nguyen, Duc M. MDb; Vulcano, Ettore MDc; Buller, Leonard T. MDb; Sheth, Pooja MDd; Jose, Jean DOd

doi: 10.1097/BCO.0000000000000702

Subfibular impingement is one cause of extraarticular ankle impingement characterized by pain in the lateral aspect of the hindfoot. Associated with severe hindfoot deformity, subfibular impingement can be secondary to posterior tibial tendon dysfunction, calcaneal fracture malunion, or neuropathic or inflammatory arthritidies. MRI often is necessary to rule out other causes of ankle pain. Advanced imaging findings are related to abutment between the fibula and calcaneus and include subcortical marrow edema, cystic changes, sclerosis, and the presence of soft-tissue entrapment or extensive soft-tissue thickening between the fibula and the calcaneus. A trial of nonoperative management should be exhausted prior to open or arthroscopic procedures being considered. However, in recalcitrant cases unresponsive to conservative treatment, there are several surgical procedures described for the management of these deforming forces.

Level of Evidence: Level V.

aOrthopaedic Specialty Institute, Orange, CA

bDepartment of Orthopedics, University of Miami Miller School of Medicine, Miami, FL

cDepartment of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY

dDepartment of Radiology, University of Miami Miller School of Medicine, Miami, FL

Financial Disclosure: Dr. Aiyer discloses a financial relationshp outside this work with Paragon 28, Medline, and Medshape. Dr. Vulcano discloses a financial relationship with Wright Medical outside this work. The other authors have no disclosures. The authors report no conflicts of interest in regard to this work.

Correspondence to Duc M. Nguyen, MD, Orthopedic Surgery Resident, University of Miami Miller School of Medicine, Department of Orthopedics, Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL 33136 Tel: +305-585-1315; fax: +305-324-7658; e-mail:

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