Ankle Impingement (Anterior) Causes, Symptoms & Treatment

A common source of chronic ankle pain among athletes is anterior ankle impingement. This condition, sometimes called “footballer’s ankle,” causes pain in the front of the ankle joint. It’s caused by buildup of scar tissue or bone spurs, usually in response to an acute injury or chronic stress on the ankle.

There are several causes of anterior ankle impingement. A common cause is chronic, repetitive strain on the ankle due to playing sports or excessive training. Activities that require repetitive bending of the foot upward (dorsiflexion) can lead to this condition. Another cause of anterior ankle impingement is a trauma to the ankle, such as a recurrent ankle sprain that results in ankle instability.

Anterior ankle impingement is most common in these sports:

• Football
• Soccer
• Volleyball
• Running
• Ballet
• Basketball

Athletes with anterior ankle impingement usually experience pain in the front of their ankle when they bend it upwards. This pain may be particularly evident when squatting, kneeling, or walking up inclines or stairs. Common symptoms also include:

• Dull ache when resting
• Tenderness to touch
• Swelling in front of the ankle
• Locking of the ankle joint

If you have symptoms associated with an anterior ankle impingement, you should see your doctor for an expert diagnosis. Your doctor will ask questions about your injury, the symptoms you’re experiencing, and the sports you play. A physical examination will be conducted to identify areas of tenderness and swelling. You may be asked to bend your ankle forward to test your range of motion. You may also be asked to perform a simple ankle impingement test, which involves lunging forward  keeping  your heel on the floor. Imaging tests, such as an x-ray or magnetic resonance imaging (MRI) test are helpful to identify bone spurs or other conditions which may be causing your symptoms.

Treatment of anterior ankle impingement usually involves rest and avoiding activities that will aggravate your injury, such as squatting, lunging, running up hills, cutting, or jumping. Conservative treatments also include:

• Ice
• Elevation of the leg
• Compression
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, to relieve pain
• Corticosteroid injections for cases of severe inflammation
• Wearing a special ankle brace to support your ankle and protect it from re-injury
• Physical therapy exercises

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Anterior Ankle Impingement

Surgery may be recommended for severe cases of anterior ankle impingement or cases that do not improve with conservative treatments. Surgery allows the removal of bone spurs or scar tissue. There are risks to having surgery. These include removing too much bone and causing instability. Another risk is restoring motion to an arthritic joint, which may cause increased pain. Your doctor and orthopedic surgeon can advise if surgery is the best treatment option for you.

Recovery time after an anterior ankle impingement can vary widely depending on the extent of the injury. Typically, it takes four to six weeks before athletes can get back to their normal activities. Recovery time can take longer for severe cases. Physical therapy will play an important role in an athlete’s recovery and return to play.