Anterior Ankle Impingement

What is Anterior Ankle Impingement?

Anterior Ankle Impingement, originally nicknamed “footballer’s ankle” and then known as “athlete’s ankle”, is a source of chronic ankle pain seen in athletes. It typically occurs in those who have played for years in sports that involve a kicking motion, with repeated ankle movements up (dorsiflexion) and/or down (plantarflexion). This is typically seen in football and other sports like volleyball, ballet and running.  Anterior Ankle Impingement is an overuse injury that slowly progresses over time.

What causes Anterior Ankle Impingement?

It occurs when bone spurs develop on the front side of the bones in the ankle. When this occurs, an athlete may develop symptoms from the spurs rubbing against each other or by pinching soft-tissues between them. The pain will be worse when bending the ankle back, making difficult for certain motions like kicking a ball.  The athlete will typically have longstanding chronic pain in the front of their ankle that becomes worse when playing sports, and they also usually have a history of multiple episodes of ankle inversion injuries (ankle turning in) during sports. They often also notice a reduction in movement of the ankle, especially while doing exercises like lunging. These symptoms often cause an athlete to reduce their athletic involvement.

How is Anterior Ankle Impingement Diagnosed?

X-rays are necessary and are the mainstay of scans which are helpful to diagnose Anterior Ankle Impingement.  A standard lateral X-ray will show the bony spurs in front of the ankle bones. An MRI may also be requested as it is useful for confirming there is no other cause of the foot or ankle pain, as well as help with surgical planning if required.

What are the Treatment Options?

Non-surgical treatments

Initial treatment recommendations are non-operative, and should consist of a period of avoidance of activities that cause the symptoms. During this time, the athlete should still be active in cardio-vascular conditioning without forceful ankle motion which could aggravate their symptoms. Regular oral anti-inflammatory use along with an ice pack are important to reduce swelling. Physiotherapy can also be helpful at this stage. The physiotherapist can work with the athlete to alter their lower extremity motion and address the mechanical factors at play.  

The use of intra-articular corticosteroid injections can also be considered, although should not be repeated too often because of potentially deleterious effects on the articular cartilage within the ankle joint. There are also biological joint injections that could be considered as well.

Surgical treatments

If non-operative treatment is unsuccessful, then surgical treatment options should be considered. This will require a thorough evaluation by a foot and ankle trained Orthopaedic Surgeon. Surgery normally consists of removing the bone spurs in the front of the ankle, as well as removing any inflamed soft-tissue in the region. Surgery is performed arthroscopically (key hole) through a few very small incisions and using a camera for assistance. 

Immediately following surgery there is a short period of relative immobilization of the ankle. This is followed by structured physiotherapy with a progression to sports-specific training for the athlete to get back to competition. The time back to full competition varies, but typically takes 3 to 6 months.