Do you suffer from pain in the front of your ankle? Do you notice that symptoms get worse when you kick a ball, stand on your toes, or walk uphill? You may be suffering from anterior ankle impingement—a condition that causes pain and inflammation and affects the range of motion in your ankle. Keep reading to find out more about anterior ankle impingement: causes, symptoms, and the many treatments available.
Also known as footballer’s ankle or dancer’s ankle, anterior ankle impingement is the most common cause of pain in the front (anterior) of the ankle joint. The condition results from increased pressure or irritation of the bones or soft tissues. In some cases, this pressure can lead to the formation of bone spurs, or osteophytes—bony projections which can then "impinge" on each other, or pinch the surrounding joint capsule and tissue.
These spurs develop as a protective mechanism in response to repeated stress or bony contact caused by repetitive motions, so it’s no surprise that the people most at risk of anterior ankle impingement are soccer players, dancers, and other athletes. However, acute trauma like an ankle sprain, or conditions like arthritis, can also lead to ankle impingement.
The pain associated with anterior ankle impingement is typically experienced during activities that involve bending the ankle upward.
Ankle Impingement Causes and Risk Factors
There are several causes and risk factors associated with anterior ankle impingement, ranging from acute trauma to inadequate warmup. Common reasons you may be suffering from anterior ankle impingement include:
Activities that repeatedly put stress on the ankle, including football, soccer, volleyball, running, ballet, basketball, jumping, deep squats, etc.
Acute trauma, such as an ankle sprain
Age—this condition slowly progresses over time, so it’s generally seen in people who are at least 25 years old
Arthritis of the ankle
Failure to warm up properly before workouts
Inadequate rehabilitation from a prior ankle injury
Lack of recovery time between training sessions
Poor athletic technique or form
Structural issues with the feet, such as flat feet or high arches
Swollen or stiff joints
Symptoms of Anterior Ankle Impingement
Visible symptoms of anterior ankle impingement include swelling and a bony bump on the front of the ankle. ( Image Reference)
If you’re suffering from any of the following symptoms, you may have anterior ankle impingement. Consult your doctor immediately.
Pain in front of ankle when flexing or bending the ankle upward
Dull ache when resting
Increased front ankle pain when walking or running, especially uphill or on uneven terrain
Tenderness when touching the front of the ankle
Feeling the ankle "click" during certain movements
Swelling of the ankle joint
Ankle weakness or instability
Limited range of motion of the ankle
A bony bump on the front of the ankle
Diagnosing Anterior Ankle Impingement
Although you may suspect you have anterior ankle impingement based on symptoms like pain in the front of the ankle when flexing, you should see your doctor or physiotherapist for a formal diagnosis. Your doctor will diagnose based on a physical exam and the results of imaging techniques.
Your doctor or physiotherapist will take your medical history and will inquire about your participation in sports and other activities. They will make a record of your symptoms and prior injuries and then perform a physical examination to check for pain, swelling, or lumps around the ankle.
X-rays or MRI scans are frequently used to diagnose anterior ankle impingement and to rule out other conditions. X-rays can highlight bone spurs, while MRI scans may uncover things an X-ray cannot, such as inflammation, fluid build-up, or injury to the cartilage.
Ankle Impingement Treatment
Many treatment options are available for anterior ankle pain, ranging from simple at-home therapies to surgery for serious cases.
RICE - Rest, Ice, Compression, Elevation
This protocol is best used within the first 72 hours following an ankle injury to kill pain, reduce inflammation, and encourage healing.
Rest. Resting your ankle allows the body time to heal. Avoid putting weight on the foot, as this can cause further inflammation and damage.
Ice. Use ice packs on your ankle to reduce pain and inflammation. Apply an ice pack for up to fifteen minutes every four hours, or as needed.
Compression. Reduce swelling and pain by using an elastic compression bandage.
Elevation. Raising the ankle helps restrict blood flow, which decreases swelling. For best results, elevate the ankle above the heart by lying down and propping the foot on a chair, stirrup, or bed frame.
Anterior Ankle Impingement Exercises
Begin rehabilitation exercises and stretches after the pain and inflammation have died down. Anterior ankle impingement exercises will improve mobility and flexibility and return strength to the ankle.
While these exercises can also be used to prevent anterior ankle impingement. Always check with your doctor or physical therapist before undertaking any new exercise regimen, and communicate if you experience any pain or swelling during treatment. Check out these commonly prescribed stretches for anterior ankle impingement:
Ankle Inversion and Eversion
Inversion & Eversion exercises are simple and can be performed simply with only the use of therapy resistance bands. This exercise works the muscles located within the lower legs and ankles.
Sit with leg extended out and loop resistance band securely around the top/ball of your foot. Keep leg still and use the therapy band to rotate foot to the outside for eversion, and inward for an inversion stretch.
Gastrocnemius & Soleus Stretches
These common exercises stretch and strengthen the muscles in the calves and lower legs.
Ankle Plantar Flexion
Try this floor exercise that uses your body weight to release tension in the ankle and along the bottom of the foot.
A soft tissue massage improves blood circulation and loosens tight muscles, which helps support the ankle, reduces pain, and encourages healing. A physical therapist can perform this type of massage as part of your recovery program.
Avoid any form of massage during the first few days after injury, as it can increase inflammation.
An ankle brace is crucial to supporting your joint, which allows your ankle impingement to heal and prevents re-injury. ( See Product)
A brace is a type of orthotic device that keeps the ankle and foot in neutral positions, aiding healing and providing pain relief. Immobilizing the ankle with a brace allows the joints and muscles to relax and heal. Ankle braces fit inside running shoes and can be worn during physical activity for extra support.
Ankle braces can be purchased over the counter or online. Be sure to choose one that is washable and made from a breathable fabric.
Anterior Ankle Impingement Taping
Taping the ankle stabilizes the joint, providing support and reducing stress on the joint, muscles, and tendons. Correct ankle taping techniques will help you return to activities sooner and reduce the likelihood of exacerbating the ankle impingement injury.
Discuss the suitability of taping techniques with your physiotherapist, who can show you the correct method for your particular injury.
If your ankle impingement is causing a lot of pain or is very swollen, your doctor may recommend anti-inflammatory medications or corticosteroid injections.
Aspirin or ibuprofen are common over-the-counter anti-inflammatory drugs, which can be taken according to the instructions on the package. These should not be taken long-term, however, as they can lead to stomach bleeding or gastrointestinal irritation.
Severe cases of ankle impingement may require corticosteroid injections. Discuss the benefits and risks of injections with your doctor.
Anterior ankle impingement rarely requires surgery. However, severe or persistent cases may need surgical intervention to remove prominent bone spurs or tissue abnormalities.
Note that surgery to remove bone spurs may not reduce symptoms in people with arthritis of the ankle.
Anterior Ankle Impingement Recovery Time
The prognosis and recovery time for anterior ankle impingement varies from person to person and depends on a number of factors, including severity, general health, and treatments employed.
If you have a straightforward case of anterior ankle impingement, you may be able to return to activities within four to six weeks. However, those with severe symptoms requiring surgery may need up to six months to completely recover before returning to strenuous activities and competitive sports.
Regardless of the severity of the condition, early intervention is key to a speedy recovery. People who use the RICE protocol along with physical therapy tend to recover faster than those who delay treatment or employ inadequate recovery techniques.
How to Prevent Anterior Ankle Impingement
As always, prevention is better than the cure! Follow these steps so you'll never need to worry about anterior ankle impingement.
1. Warm Up
Failure to warm up is a leading cause of sports- and workout-related injuries. Taking time to stretch before activities will help prevent anterior ankle impingement—and keep you flexible and mobile.
Warm-up exercises to prevent ankle impingement are the same as the rehabilitation exercises listed above.
2. Change your Workouts
If you are repeatedly putting stress on your ankle through exercises such as deep squats, jumping, football, or ballet, you are at risk of developing anterior ankle impingement.
Consider mixing up your workout routine by choosing low-impact activities on alternate days. Examples include swimming, an elliptical machine, or yoga.
When you do engage in activities that put stress on your ankles, ensure you are using proper form to reduce the risk of injury.
3. Support the Ankles
Supporting the ankles with insoles is key to reducing the stress on your joint and preventing further damage. ( See Product)
Support the joints in your feet and ankles by choosing appropriate and supportive footwear and insoles.
Also, consider the terrain you’re training on. When possible, workout on a running track or padded exercise mat, both of which help absorb some of the impact and reduce stress on the ankle.
4. Address Structural Issues
When certain parts of the body are out of balance, the other muscles and joints pick up the slack. For example, if you have flat feet or high arches, you may be putting additional strain on your ankles, increasing your risk of injury. Address these issues through the use of orthotics, physical therapy, and if necessary, medical interventions.
5. Take a Break
Give your ankles time to recover between training sessions. Schedule recovery days, rest, eat well and get enough sleep. If you do sustain an ankle injury, get the all-clear from your doctor or therapist before returning to activities.
Fight Anterior Ankle Impingement Pain
Anterior ankle impingement is a common condition, but one which is easily preventable.
Our feet and ankles do so much for us—literally supporting us in all we do. They deserve our support, too. Provide your ankles with adequate resting periods, orthotic supports, and daily stretching to avoid the pain and inflexibility associated with anterior ankle impingement.
If you’re worried you may already have ankle impingement, consult a doctor.
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