Impingement

Ankle Impingement is a condition where pain is experienced due to compression of the bony or soft tissue structures during a specific range of motion. Anterior Ankle Impingement, also known as Footballer’s Ankle, is pain at the front of the ankle during maximal ankle dorsiflexion motions.

Causes

Anterior ankle impingement most commonly occurs as a result of:

• Ankle Sprain
• Recurring Ankle Sprains
• Activities that require repeated Dorsiflexion of the Ankle – such as landing and deep squatting.
• Inadequate rehabilitation following a previous ankle injury
• Joint stiffness or swelling
• Muscle tightness
• Bony anomalies
• Poor foot biomechanics (e.g. “flat feet” or high arches)
• Poor lower limb biomechanics
• Inappropriate training (including technique, footwear or training surfaces)
• Excessive training
• Inadequate recovery periods from training and games
• Inadequate warm-up
• Poor core stability
• Poor balance or proprioception (the sense of the relative position of neighboring parts of the body)

Symptoms

The most common symptom is a dull ache at the front of your ankle while resting, which then becomes a sharp pain at the front of the ankle when it bears weight or following excessive dorsiflexion. Other symptoms are puffiness or swelling of the ankle joint.

Symptoms are increased during the following activities:

• Walking or running excessively (especially up hills or on uneven surfaces)
• Deep squatting or lunging (especially with the knee moving forward over the toes)
• Landing from a jump (particularly on an incline or an uneven surface)
• Performing a calf stretch (particularly with the knee bent)
• Heavy lifting or twisting activities
• Tenderness on palpation of the front of the ankle joint.
• In some cases, a clicking sensation may be experienced during certain ankle movements.

Potential Treatments

Provide Pain Relief, Injury Protection & Minimize Swelling:
Managing pain is the main reason that people seek treatment for anterior ankle impingement. In truth, it is often the final symptom developed, but the first symptom to improve.

Restore Full Range of Motion:
As soon as you feel comfortable, you should start your rehabilitation. You should aim to regain an adequate range of motion in your ankle.

Restore Muscle Strength:
Your calf, ankle and foot muscles will require strengthening to recover from the injury and prevent future episodes. It is important to regain normal muscle strength to provide normal dynamic ankle control and function.

Restore High Speed, Power, Proprioception and Agility.
Most cases of anterior ankle impingement occur during high-speed activities, which place enormous forces on your ankle and adjacent structures. Balance and proprioception are required to ensure a full recovery and also to prevent further injury.

Return to Normal Daily Functions and Sports.
Once you are able to return to normal daily functions (like walking, taking the stairs and squatting) you can start exercises focused on your specific needs. If you play a sport, you may need sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

Surgery:
Surgery is not common for those suffering from anterior ankle impingement. However, in persistent cases of anterior ankle impingement, operative treatment may be beneficial, particularly for a high-level athlete. Your doctor will determine the best approach based on your evaluation.