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Ankle impingement occurs when soft tissues or bones in the ankle become compressed during movement, leading to pain and restricted motion. It is common in athletes and people with a history of repeated ankle sprains.

There are two main types:

  • Anterior impingement (front of the ankle) – pain and restriction when bending the foot upwards.
  • Posterior impingement (back of the ankle) – pain and restriction when pointing the toes down.

Both types can involve bone spurs or thickened soft tissue that interfere with normal movement.

Ankle Anatomy

The ankle is a hinge joint made up of three bones:

  • Tibia (shinbone) – the main weight-bearing bone of the lower leg.
  • Fibula – the smaller bone on the outside of the lower leg that provides stability.
  • Talus – the bone in the foot that connects to the tibia and fibula, allowing movement.

These bones are supported by ligaments, tendons, and cartilage, which help provide stability and smooth movement. The joint moves in two primary directions:

  • Upward bending (dorsiflexion) – when the toes move towards the shin.
  • Downward pointing (plantarflexion) – when the foot points downwards.

Impingement occurs when structures in the ankle become compressed during these movements, leading to pain and limited motion.

Signs & Symptoms

Anterior Impingement

  • Pain at the front of the ankle, especially when bending the foot upwards.
  • Swelling and tenderness around the front of the ankle.
  • A “blocked” feeling when trying to fully bend the ankle.
  • Pain during activities like squatting, climbing stairs, or running uphill.
  • Stiffness and reduced movement over time.
  • History of repeated ankle sprains or instability.

Posterior Impingement

  • Pain deep in the back of the ankle, especially when pointing the toes down.
  • Swelling and tenderness at the back of the ankle.
  • A catching or locking sensation in the ankle.
  • Common in ballet dancers, soccer players, and cricketers.
  • Pain when wearing high heels or going downstairs.

Causes and Contributing Factors

Anterior Impingement

  • Repetitive upward bending of the foot, common in running and jumping sports.
  • Bone spurs forming from repeated impact.
  • Ankle instability after previous sprains, leading to excess movement.
  • Thickened or scarred soft tissue after injury.
  • Foot posture issues, like high arches, which can alter ankle mechanics.

Posterior Impingement

  • Repetitive downward pointing of the foot, common in ballet and kicking sports.
  • Extra bone at the back of the ankle, which can become compressed.
  • Thickened or irritated soft tissue from overuse.
  • Previous ankle sprains causing long-term changes in movement.
  • Arthritis or old fractures leading to bony overgrowth.

Treatment

Physiotherapy & Conservative Management

A trial of 3–6 months of conservative treatment is recommended before considering surgery. Physiotherapy focuses on reducing pain, restoring movement, and preventing recurrence.

General Strategies

  • Activity Modification: Avoid movements that worsen symptoms (e.g., deep squatting, repetitive jumping).
  • Ice & Anti-Inflammatory Medication: Help reduce swelling and discomfort.
  • Ankle Bracing or Taping: Provides support and limits excessive motion.
  • Footwear Adjustments & Orthotics: Heel lifts may help reduce excessive ankle movement.

Manual Therapy Techniques

Hands-on therapy is used to reduce compression, improve movement, and relieve pain. Techniques may include:

  • Soft Tissue Release to ease tension around the ankle.
  • Joint Distraction to create space in the joint and reduce compression.
  • Guided Movements to improve flexibility while minimising pressure on the affected area.

Exercise-Based Rehabilitation

  • Stretching & Strengthening:
    • Calf stretching to improve mobility.
    • Single-leg balance exercises to improve stability.
    • Resistance exercises for ankle and foot muscles.
  • Functional Training:
    • Squats, lunges, and sport-specific exercises to prepare for return to activity.

Injection Therapy

  • Corticosteroid injections may provide short-term relief by reducing inflammation.
  • Ultrasound-guided injections may help with targeted pain management.

Surgical Management

Surgery is only considered if conservative treatment does not work after 3–6 months. The goal is to remove bone spurs, excess tissue, or other structures causing compression while preserving normal ankle function.

Arthroscopic Surgery (Minimally Invasive)

  • Considered the gold standard for ankle impingement due to faster recovery and earlier return to activity compared to open surgery.
  • Performed through small incisions using a camera and specialised instruments.
  • Bone spurs and thickened tissue are removed to restore ankle movement.

Open Surgery

  • Reserved for complex cases or when other procedures need to be done at the same time.
  • Requires a larger incision and has a higher risk of complications, such as scar tissue formation or nerve irritation.

Post-Surgical Rehabilitation

  • Early movement is encouraged to prevent stiffness.
  • Gradual return to weight-bearing (crutches may be used initially).
  • Strength and balance exercises progress over 3–6 months.
  • Return to sport is typically within 3–6 months, depending on recovery.

Complications

  • Nerve irritation is the most common complication.
  • Other risks include infection, swelling, and scar tissue formation.
  • In rare cases, bony growths can return over time, requiring further treatment.

Surgical Success Rates

  • Studies report 75–96% success rates with arthroscopic debridement for soft tissue impingement.
  • Most patients experience significant pain relief and improved movement.
  • Athletes can return to sport within a few months if rehabilitation progresses well.

Prognosis

The recovery timeline for ankle impingement depends on the severity of the condition and the effectiveness of treatment:

  • Mild cases may resolve within a few weeks to months with physiotherapy and activity modification.
  • Moderate cases often require several months of rehabilitation to restore normal function and prevent recurrence.
  • Severe cases or those requiring surgery may take 3–6 months to fully recover.

Most individuals can return to daily activities relatively quickly, while athletes typically regain full function within 3–6 months if rehabilitation progresses well. Early diagnosis, adherence to physiotherapy, and ongoing joint care and strengthening improve long-term outcomes and help prevent recurrence.

Information is provided for educational purposes only. Always consult your physiotherapist or other health professional.

References

Murawski, C. D., Kennedy, J. G. (2016). Anteromedial impingement in the ankle. EFORT Open Reviews, 1(2), 39–44. https://doi.org/10.1302/2058-5241.1.000009

de César Netto, C., Schon, L. C., Dayan, A. J., et al. (2021). Current concepts review: Anterior ankle impingement. JISAKOS, 6(5), 296–304. https://doi.org/10.1016/j.jisako.2021.06.005

Urgüden, M., Cevikol, C., Dabak, K., & Sehirlioglu, A. (2012). Arthroscopic treatment of anterolateral soft tissue impingement of the ankle. Journal of Orthopaedic Surgery and Research, 7, 23. https://doi.org/10.1186/1749-799X-7-23

van den Bekerom, M. P. J., Raven, E. E. J., Theumann, N. H., & van Dijk, C. N. (2012). Posterior ankle impingement. Journal of the American Academy of Orthopaedic Surgeons, 20(9), 542–549. https://doi.org/10.5435/JAAOS-20-09-542

O’Kane, J. W., Kadel, N. J. (2016). Anterior ankle impingement in dancers. Journal of Orthopaedic Surgery and Research, 11, 80. https://doi.org/10.1186/s13018-016-0430-x