Anterior ankle impingement
Anterior ankle impingement is a condition where an individual experiences discomfort and pain in the front part of their ankle. This is caused by compression of the bony or soft tissue structures during activities that involve maximal ankle dorsiflexion motion (bending the foot up). Other names for this condition include anterior ankle impingement syndrome, footballer’s ankle, anterior impingement of the ankle and ankle impingement.
There are two bones in the ankle joint – the tibia and talus. These two bones glide on one another and have cartilage that cushions the impact of the tibia on the talus during activities the involve weight-bearing. When moving the ankle dorsiflexion (foot up position), the shin and foot move towards each other, which means that the tibia approaches the front of the talus. The result is that this places pressure on the structures at the front of the ankle joint. Inflammation and injury can occur when this pressure is too intense, beyond what the ankle can withstand.
Repeated pressure at the front (anterior aspect) of the ankle joint results in pinching of the joint capsule and other soft tissue structures. This is responsible for causing pain in patients with anterior ankle impingement.
In some cases, this pressure on the anterior ankle joint can result in bone spurs, which is also known as an osteophyte. Bone spurs develop to help protect the affected surface from repeatedly pulling on the front tip of the tibia. This process is not necessarily associated with arthritis of the ankle joint.
Ankle sprains, activities that require repeated dorsiflexion of the ankle (for example deep squatting) and recurrent ankle injuries are the common causes of anterior ankle impingement.
Various factors can predispose you to develop anterior ankle impingement. A chiropractor or physiotherapist is able to identify these factors and correct them to reduce the risk of developing anterior ankle impingement.
Factor that contribute to the development of this include:
- Muscle tightness
- Bony anomalies
- Inadequate rehabilitation from an ankle injury
- Poor lower limb biomechanics
- Inadequate recovery from training
- Excessive training
- Joint stiffness or swelling
- Poor foot biomechanics
- Poor proprioception or balance
- Unsuitable training technique and footwear.
Those who suffer from anterior ankle impingement, can experience:
- Increased symptoms from partaking in particular activities, such as excessive: walking, running, squatting, lunging, jumping and landing, performing calf stretches, twisting activities or heavy lifting
- Tenderness, inflammation or swelling of the ankle joint
- Clicking sensation during particular ankle movements
- Ache at the front of the ankle with activity.
Your chiropractor or physiotherapist can diagnose anterior ankle impingement from asking you about your history and conducting a physical assessment of your ankle. You may be advised to obtain x-rays to assist in the evaluation.
X-rays: X-rays can be helpful when assessing anterior ankle impingement as it can show the ankle structures and can identify bone spurs.
Magnetic Resonance Image (MRI): An MRI is useful for a few different reasons. It can provide clarity that there is no other foot or ankle problems that could be mimicking anterior ankle impingement. An MRI can also show signs of swelling and inflammation in the front of the ankle. This can help confirm the patient’s ankle history and physical examination and help plan any future surgery.
Stage one: pain relief, minimise swelling and injury protection
Pain is the prime reason that treatment for anterior ankle impingement is sought.
Rest: Our first approach is to decrease pain caused by provoking postures and movements through active rest. The first step is to stop doing the movement or activity that provokes the particular ankle pain.
Ice: A simple and easily accessible way to reduce your pain and inflammation is by applying ice.
There are various treatments that your chiropractor or physiotherapist will use to reduce your pain and inflammation. These include ice, dry needling, electrotherapy, soft tissue massage, unloading taping techniques and temporary use of a mobility aid (i.e. brace) to off-load the injured structures for a short period.
In more severe cases, your chiropractor or physiotherapist will recommend rest from the particular activity that causes aggravation and recommend alternative exercises. To help reduce pain and inflammation medications may be needed as directed by a medical practitioner.
Stage two: restore full range of motion
Throughout the treatment process, the aim is to begin rehabilitation and regain full active range of motion of the ankle. Your chiropractor or physiotherapist will monitor when you are ready and when it is comfortable to do so.
Stage three: restore muscle strength
To recover from the injury preventing any future ankle injuries occurring, strengthening is required on your calf, ankle and foot muscles. It’s important to regain normal muscle strength to provide normal dynamic ankle control and function. Strength and power will gradually progress from non-weight bearing to partial and eventually, full weight-bearing exercises. Strengthening may also be required on your other leg and core muscles, depending on your assessment findings. Your chiropractor or physiotherapist will advise you.
Stage four: restore high speed, power, proprioception and agility
Most cases of anterior ankle impingement occur during high-speed activities that place force on your ankle and adjacent structures. To ensure a full recovery and prevent re-injury, proprioception (the sense of the relative position of neighbouring parts of the body) and balance exercises are required.
Stage five: return to sport
Depending on your needs such as squatting and walking, your chiropractor or physiotherapist will advise on your return back to sports. To successfully return to sport, you may require specific sport-related exercises and a tailored training routine to ensure a safe an injury-free return to sport. Your chiropractor or physiotherapist will discuss the objectives, goals and training of your schedule with you.
Ultimately, the perfect outcome will include you performing at full speed, agility and power with added knowledge on how to prevent future injuries.
This can be needed in some cases and should be discussed with a surgeon