Having a pinching sensation in the front of the ankle is not unusual. This is especially true for athletes that have suffered from ankle injuries including sprains. As a practicing orthopedic physical therapist, I have seen and treated multiple people with anterior ankle impingement. This condition often occurs after other injuries, like a serious ankle sprain, but can present on it’s own. If caught early, it responds very well to physical therapy. Read on to learn more about anterior ankle impingement. Let’s start with anatomy!
Joints of the ankle
The ankle has two main joints. These are the talocrural and subtalar joints.
- The talocrural joint is made up of the talus and the lower ends of the tibia, and fibula. The talus is the bone that sits above the calcaneus (the heel bone). The tibia and fibula are the lower leg bones. This joint allows for plantar flexion (pointing the foot down) and dorsiflexion (pointing the foot up).
- The subtalar joint is made up of the talus and the calcaneus. This joint allows for eversion and inversion. Eversion is when the ankle and arch roll inward and inversion is when the ankle and arch roll outward
- All four motions of the ankle are vital in order for the foot and ankle to walk and move normally.
What is anterior ankle impingement?
Anterior ankle impingement occurs when soft tissue, scar tissue, or bone is compressed or pinched at the talocrural joint. The pinching and pain occur at the front area of the ankle with dorsiflexion (flexing the foot up toward the shin). It is also called “athlete’s ankle” or “footballer’s ankle” because it is common in athletes. It is caused by repeated dorsiflexion movements, micro-trauma to the front of the ankle, and recurrent ankle sprains. It can be further broken down into 2 different categories.
- Anteriormedial
- Caused by recurrent ankle sprains, repetitive dorsiflexion, and repeated micro-trauma to the front of the ankle.
- An example of repetitive micro-trauma includes forceful kicking of the ball in soccer
- Pain and entrapment is in the front inside area of the ankle.
- Recurrent micro-trauma to the front of the ankle could cause bone spurs to form around the talocrural joint.
- This category of impingement tends to be more bony impingement.
- Caused by recurrent ankle sprains, repetitive dorsiflexion, and repeated micro-trauma to the front of the ankle.
- Anteriorlateral
- Caused by recurrent ankle sprains and chronic ankle instability.
- Pain and entrapment is in the front outside area of the ankle.
- About one third of those with chronic ankle instability will have anterior ankle impingement.
- This leads to pain, inflammation, and scar tissue formation in the front outside area of the ankle.
- This category of impingement tends to be more soft tissue impingement.
What are the symptoms of anterior ankle impingement?
There are several symptoms associated with anterior ankle impingement. These symptoms include:
- Pain in the front or outside of the ankle
- Blocking sensation in dorsiflexion (flexing the foot up towards the shin)
- Swelling of soft tissue over the front of the ankle joint
- Feeling of instability at the ankle
- Limited movement at the ankle
- Pain with squatting, sprinting, and climbing stairs
- Symptoms might develop gradually or occur after an injury
Are there risk factors for anterior ankle impingement?
There are several risk factors for this condition. These include:
- Activities that require repeated dorsiflexion
- Gymnastics
- Soccer
- Football
- Dance
- Running
- Not wearing shin guards during practice
- Recurrent ankle sprains
- Chronic ankle instability
Who should I see?
- Physical therapy – Conservative treatment is the first approach in treating anterior ankle impingement. This includes physical therapy. Your PT can help decrease the pain and swelling. Abnormal joint mobility, weakness, instability, and flexibility will be evaluated and addressed. Your PT will also assess your form during sport to help with any abnormalities that might be causing injury.
- Orthopedic physician – An orthopedist will be necessary if the condition is not responding to physical therapy. Anti-inflammatory medication or an injection might be needed to decrease the inflammation. Imaging can be used to determine the extent of the injury, and if it is bony or soft tissue that is causing the problem. Surgery is an option if the condition is not improving with conservative treatment, or if a bone spur is interfering with joint mobility.
What can I do at home?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to decrease treat anterior ankle impingement. Basically stay away from the activities that are causing pain until the pain and inflammation have subsided. This gives the area time to rest and heal. If you keep doing what is causing the inflammation, it is not going to get better. Swimming and biking would be good alternative activities that do not put much stress through the ankle and foot.
- Ice – Ice can help decrease the pain and swelling at the ankle. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or preventing you from participating in an activity. Ice immediately after activity.
- Mobilizing the talocrural joint – Mobilizing the front of the joint can help increase the mobility of the joint and decrease pain with dorsiflexion movements. Using a strong resistance band will help the mobilization. The video below reviews how to mobilize your ankle.
- Stretching – The calf muscle is going to get tight and potentially painful if you are unable to freely dorsiflex the foot. Stretching the calf muscle will help. Only stretch as far as it feels comfortable. Stop if you start getting pinching in the front of the ankle. See the video below.
- Strengthening – It is important to strengthen the muscles around the ankle, knee, and hip. All of these muscles work together to stabilize the ankle while squatting, running, cutting, and jumping. Using loop resistance bands, resistance bands and ankle weights can increase strength and difficulty of the exercises. See the videos below.
- Balance – Working on balance is important in strengthening the foot and ankle but also improving proprioception. Improving proprioception will help improve the overall stability of the ankle. See the video below.
- Balance video
- Bracing – Using a stability brace or ankle sleeve can be helpful to decrease pain and improve stabilization at the ankle. This is especially useful for those that have chronic ankle instability or who have suffered from previous ankle injuries.
- Compression socks – Compression socks can help decrease swelling and pain by improving circulation. It is important to put on compression socks after first waking up in the morning. This is usually when there is the least amount of swelling.
In review
- The ankle has two main joints.
- These are the talocrural and subtalar joints.
- Anterior ankle impingement occurs when soft tissue, scar tissue, or bone is compressed or pinched at the talocrural joint.
- The pinching and pain occurs at the front area of the ankle with dorsiflexing or flexing the foot up toward the shin.
- It is also called “athlete’s ankle” or “footballer’s ankle” because it is common in athletes.
- It is caused by repeated dorsiflexion movements, micro trauma to the front of the ankle, and recurrent ankle sprains.
- Symptoms include
- Pain in the front or outside of the ankle
- Blocking sensation in dorsiflexion (flexing the foot up towards the shin)
- Conservative treatment including physical therapy is the first approach in treating the ankle.
- An orthopedist would be needed if the condition is not responding to physical therapy.
- There are things that you can do
- Relative rest
- Ice
- Mobilizing the ankle
- Stretching
- Strengthening
- Balance
- Brace
- Compression socks
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.sciencedirect.com/science/article/pii/S2059775421001346
https://www.choosept.com/guide/physical-therapy-guide-ankle-impingment
https://www.physio-pedia.com/Ankle_Impingement