Anterior ankle impingement

Anterior ankle impingement is a condition where repetitive forces compress and damage the tissues at the front of the ankle, causing pain and inflammation. It is a common injury that can affect people of all ages, however is usually seen in athletes of sports involving repetitive or forceful upward movements of the ankle, such as sprinting, landing from long jump, uphill and downhill running.

What are the symptoms?
Pain at the front of the ankle joint is the primary symptom of anterior ankle impingement. This can be felt as an intense, sharp pain occurring with ankle movements or a dull ache in front of the ankle following periods of exercise. Pain can also be felt when putting weight through the ankle while standing, walking or running. Night soreness, stiffness, swelling and reduced ankle flexibility are also common symptoms. 
 
How does it happen?
Anterior ankle impingement is caused by traumatic or repetitive compression to the structures at the front of the ankle as the tibia and talus move towards each other during ankle movements. The tissues that are affected become damaged and inflamed, causing the pain typical of ankle impingement. Chronic inflammation can lead to further stiffness, exacerbating the impingement process.
 
The most common risk factor for ankle impingement is a previous ankle sprain that was not adequately rehabilitated, as this can result in a stiff or unstable ankle. Another cause of impingement is the growth of small osteophytes or bony spurs around the ankle joint that press against the nearby soft tissues. These can be due to osteoarthritis or grow as a reaction to previous injury.  Training errors, muscle tightness, unsupportive footwear and a hypermobile ankle have also been shown to be risk factors for anterior ankle impingement.
 
How can physiotherapy help?
Depending on the cause, mild cases of anterior ankle impingement usually recover in one to three weeks with rest and physiotherapy treatment. For more severe impingement, the ankle may require up to six weeks of rest and rehabilitation to recover. In rare cases, surgical intervention will be required to remove any physical causes of impingement such as osteophytes, to restore impingement free movement of the ankle.

Your physiotherapist will first identify the cause of your ankle impingement and help you to choose the best course of action to reduce your symptoms. They are able to advise you on the appropriate amount of rest and provide stretches and exercises to restore strength and flexibility to the ankle.

Mobilization techniques and range of motion exercises can also reduce stiffness of the ankle, restoring normal joint movement. Balance and proprioception exercises are also included to help prevent further ankle injury. 

Physiotherapy treatment is definitely the first step before considering surgery. If surgery is required however, your physiotherapist can help you to make a full recovery with a post surgical rehabilitation program.