Sports Medicine
Sports Injury Prevention & Rehabilitation

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Anterior Ankle Impingement

Also known as Ankle Impingement, Anterior Impingement Syndrome, Anterior Impingement of the Ankle)
What is anterior ankle impingement?
The talus is a small bone of the ankle responsible for transferring weight bearing forces from the shin to the foot. During the movement of ankle dorsiflexion, i.e. when the foot and shin move towards each other, the bottom of the shin bone approaches the front of the talus. This places compressive forces on the structures at the front of the ankle joint. If these forces are excessive or beyond what the ankle can withstand, damage and inflammation of these structures may occur. This condition is known as anterior ankle impingement. Occasionally, bony spurs can also form at the front of the ankle joint which may contribute to the problem.

Causes of anterior ankle impingement
Anterior ankle impingement sometimes occurs following an ankle sprain or due to activities requiring repeated forced dorsiflexion.

Signs and symptoms of anterior ankle impingement
Patients with this condition typically experience pain at the front of the ankle that increases with excessive dorsiflexion or weight bearing activities such as running.

Treatment for anterior ankle impingement
It is recommended that patients with anterior ankle impingement undergo a therapy program as the first line of treatment. One of the key components of this program is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once this is achieved a gradual return to activity is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain no gain' attitude is likely to aggravate the condition and may lead to the problem becoming chronic. Immediate appropriate treatment is essential to ensure a speedy recovery.
In the initial phase of injury. RICE is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). RICE involves rest from aggravating activities (crutches may be required), regular icing, the use of a compression bandage and keeping the leg elevated. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
A graduated and pain-free flexibility, strength and return to activity program under direction from a therapist is vital to ensure an optimal outcome.
Alternative exercises placing minimal weight bearing forces through the ankle should be performed to maintain fitness such as swimming, cycling, and water running.

Contributing factors to the development of anterior ankle impingement
There are several factors which can predispose patients to developing anterior ankle impingement. These need to be assessed and corrected with direction from a therapist. Some of the factors which may contribute to the development of this condition include:
  • joint stiffness or swelling
  • muscle tightness
  • poor foot mechanics
  • inappropriate training (including technique, footwear or training surfaces)

Physical therapy for anterior ankle impingement
Physical therapy treatment is vital to hasten the healing process and ensure an optimal outcome in all patients with this condition. Treatment may comprise:
  • soft tissue massage
  • joint mobilization
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • stretches
  • taping
  • bracing
  • crutches
  • ice or heat treatment
  • exercises to improve flexibility, strength and balance
  • education
  • activity modification advice
  • biomechanical correction
  • a gradual return to activity program

Other intervention for anterior ankle impingement

Despite appropriate therapy management, some patients with this condition do not improve. When this occurs the treating therapist can advise on the best course of management. This may include a corticosteroid injection, X-rays or other investigations, or for those patients with prominent bony spurs, surgical intervention may be indicated to remove the bony spur.