What is anterior ankle impingement?
The talus is a small bone of the ankle responsible for transferring weight bearing forces from the shin to the foot. During the movement of ankle dorsiflexion i.e. when the foot and shin move towards each other, the bottom of the shin bone approaches the front of the talus. This places compressive forces on the structures at the front of the ankle joint. If these forces are excessive or beyond what the ankle can withstand, damage and inflammation of these structures may occur. This condition is known as anterior ankle impingement. Occasionally, bony spurs can also form at the front of the ankle joint which may contribute to the problem.
Causes of anterior ankle impingement
Anterior ankle impingement sometimes occurs following an ankle sprain or due to activities requiring repeated forced dorsiflexion.
Signs and symptoms of anterior ankle impingement
With anterior ankle impingement, the pain is worse with walking or running up hill, inclines or stairs. Squatting (eg with weight lifting) and landing after a jump (eg gymnastics or acrobatics) may make this pain worse. Sometimes the patient may be able to localize this pain to the inner or outer side of the ankle. There is limited range of ankle motion, particularly in dorsiflexion. Anterior ankle spurs are the most common cause of anterior impingement. The cause of the anterior spurs is unknown and they most likely are the result of repetitive minor injuries. Anterior impingement secondary to spur formation is quite common in athletes especially in soccer, rugby and basketball
Treatment for anterior ankle impingement
Ignoring symptoms or adopting a ‘no pain no gain’ attitude is likely to aggravate the condition and may lead to the problem becoming chronic. Immediate appropriate treatment is essential to ensure a speedy recovery.
Patients with this condition should follow the R.I.C.E. regime in the initial phase of injury. The R.I.C.E regime is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). The R.I.C.E. regime involves rest from aggravating activities (crutches may be required), regular icing, the use of a compression bandage and keeping the leg elevated. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
A graduated and pain-free flexibility, strength and return to activity program under direction from a orthopaedic doctor is vital to ensure an optimal outcome.
Alternative exercises placing minimal weight bearing forces through the ankle should be performed to maintain fitness such as swimming, cycling, and water running.