What is it?
Anterior ankle impingement or syndrome is a musculoskeletal condition caused by repetitive compressive forces that damage the tissues at the front of the ankle. As a result there is often pain and stiffness at the front of ankle. This injury is most commonly seen in sportspeople that complete repetitive movements of the ankle, such as sprinting, landing, and hill running.
What are the symptoms?
Pain at the front of the ankle, this can be sharp during certain movements or a dull ache following periods of exercise. Pain during weight bearing activities such as standing, walking or running is also very common. Increased stiffness, swelling and aching are typical symptoms that occur at the end of the day and at night time.
How does it happen?
The ankle joint comprises of multiple structures; such as bone, ligaments and tendons. During ankle dorsiflexion (foot towards head) the tibia and talus bones move towards each other. If this movement occurs repetitively and traumatically then it leads to damaged and inflamed tissues. Over time the condition can become chronic, leading to further stiffness, thus exacerbating the impingement process.
Having a previous ankle sprain is the most common risk factor for anterior ankle impingement. If the sprain was not adequately rehabilitated, there is often residual stiffness or instability. Small osteophytes (bony spurs) are another cause of this condition, as the bony spurs press repetitively against other tissues. Osteophytes may grow due to osteoarthritis or as a result of the anterior impingement itself. Other risk factors include: poorly planned training programs, muscle tightness, unsupportive footwear, and a hypermobile ankle joint.
How can physiotherapy help?
Your physiotherapist can help reduce the pain in your ankle and identify the cause(s) of your ankle impingement. After completing a thorough assessment your physiotherapist will propose a treatment plan to get you back doing your desired activities pain-free. Typically, this will involve a period of modified activity in order for the inflammation to settle. As well as accompanying treatment such as mobilisation techniques, soft tissue massage and range of motion exercises. As part of your rehabilitation, proprioception or balance exercises will be necessary to improve the control of your ankle. If there are any other identified deficits, additional treatment will be provided to address those.
In severe cases, surgical intervention may be recommended by your physiotherapist in order to reduce physical causes of the impingement such as osteophytes removal. Thus, allowing a greater impingement free range of motion. However, generally this condition will respond well to appropriate non-surgical treatment.