Anterior ankle impingement is a condition in which pain is experienced in the front of the ankle during ankle motion, squat, sprint, stair climb or hill climb. In people with ankle sprains, 20-40% have chronic ankle pain and of these patients one third has anterior ankle impingement pain. It is frequently seen in soccer, football, volley ball players, runners and ballet dancers. Medically, it is defined as an abnormal entrapment or contact of structures resulting in pain and restricted motion.

The cause of the ankle impingement syndrome is unknown. However, there are many theories which are believed to be the cause of this syndrome. First, the theory of traction injury. Traction to the anterior capsule during plantar flexion ( toes pointing down), damages the capsule and the capsule thickened, causing impingement. The second theory is accepted by most medical professionals. It is the repetitive impaction injury to the anterior chondral margin from hyper-dorsiflexion ( toes pointing up). Other theories are thickened ligament, synovium and traumatic fibrous band can all impinged in the front of the ankle. Another theory explained that there is a triangular space in the front of the ankle. Within that space lies fat and synovial tissues. When the ankle dorsi-flexed (toes pointing up), these structures are compressed, resulting in pain and discomfort. Repetitive compressions of these structures cause bone spurs to formed, leading to the decrease in ankle range of motion.

Most common symptoms are dull, pinching pain, pain with walking, squatting, landing from a jump, and climbing stairs. Pain is located in the front of the ankle. Range of motion is limited due to pain and a feeling  something is blocking the ankle to go through its range of motion. Tenderness and gritty feeling in the ankle. Pain occurs because there is not enough range of motion in the ankle for it to perform its normal functions.  Furthermore, decrease in the ankle ability to bend upward forces the leg to compensate resulting in poor walking pattern.  Hence, pain in the arch develops, the knee bows backward and the foot inside arch collapses.

Most effective treatment for this condition is distraction manipulation, mobilization of the ankle joint and foot bones then progress to ankle, knee and hip strengthening exercises and finally to more advance training in balance and proprioception.

by Raj Issuree, MPT

For more information on the anterior ankle impingement, call STARS physical therapy.

References:

Lavery KP, McHale KJ et al. Ankle impingement. J Ortho Surg Res 2016; 11(1): 97

Tol JL, van Dijk CN. Anterior ankle impingement. Foot and ankle Clin 2006; 11(2): 297-310

Talusan PG, Toy J et al. Anterior ankle impingement: Diagnosis and treatment. J Am Acad Orthop Surg 2014; 22(5): 333-9