Ankle Impingement

Ankle injuries are one of the more common problems encountered by athletes. Most injuries are sprains from a rolling injury. Some are fractures, particularly in children, that often involve the growth plate and can lead to long-term serious consequences in growth.

Other than the broken bones that require treatment by a physician, a majority of ankle injuries can be treated with simple rest, ice, compression and elevation. The duration of activity limitation depends on the severity of the ankle injury, but in almost all cases it should not last longer than three months.

If your child has been experiencing pain or a limitation in sports because of the ankle injury for longer than that, there is a chance that ankle impingement is the cause.

Ankle Impingement
Ankle Impingement

What is ankle impingement?

Words with similar meanings to impingement are bash, collide, impact, smash or strike, and can be related to pinching, especially in this context. There are two locations and three types of ankle impingement. This problem can occur in the front of the ankle or in the back. The more common type is in the front and is the focus of this discussion. The types of ankle impingement are related to the cause of pinching. It can be scar tissue (the most common cause in kids), an extra amount of ligament, or a bone spur (the most common cause in adults); but, all three can occur in children.

Most kids experience this problem as pain with activity, and not at rest. If asked to point to the tender spot, they will touch the soft spot in the front outside portion of the ankle (though this can vary). It usually hurts when the ankle is bent up (especially with running and jumping).

How did my child get ankle impingement?

The different types of impingement have different causes, but the most common cause is an ankle sprain that developed too much scar tissue during the healing process. Occasionally, the problem is related to a loose ankle, what physicians call ankle instability. However, it should be noted that instability will more often cause recurrent, or multiple, ankle sprains and not necessarily chronic, or continuous, ankle pain.

How can ankle impingement be treated?

For sports with high risk of ankle sprains (those that involve cutting or use cleats to secure footing), prevention is important. Prevention is performing strengthening exercises and using appropriate shoes.

Once an ankle injury is sustained, following the rest, ice, compression and elevation program can limit the risk of developing too much scar tissue. For those who developed ankle impingement, a research study was performed at our facility to compare the different treatments. When rated on a pain and activity scale (best score being 100) kids average 68 points when they first came to us. After physiotherapy they did not improve by even a single point. However, after surgery to remove the pinching tissue, they averaged a score of 90, with almost all kids returning to their previous level of athletics. If ankle impingement is diagnosed, then the best treatment is surgery to clean out the scar tissue or the other impinging tissue.

You should contact your doctor if your child has ankle pain with immediate or significant swelling, or if the pain does not improve after two weeks of rest, or if the pain is associated with a fever.

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