Guide to Anterior Ankle Pain Caused By Impingement

Trauma or overuse can cause anterior ankle pain. When this discomfort concentrates at the front of the ankle, it may indicate anterior ankle impingement. This condition develops as structures within the ankle joint become irritated or compressed during movement, resulting in pain and inflammation.

Early diagnosis and treatment of anterior ankle impingement can prevent the condition from worsening and restore normal ankle function. In this article, we will understand its symptoms, causes, and treatment options so you can take steps to manage pain and reduce chronic ankle pain symptoms.

What Is Anterior Ankle Impingement?

The ankle joint is a complex structure composed of bones, ligaments, and cartilage working together to enable smooth movement. When these components become inflamed, thickened, or scarred, the excess soft tissue can be trapped within the ankle joint during movement. This can lead to swelling and reduced ankle mobility.

This phenomenon, known as anterior impingement or footballer's ankle typically develops from repetitive motions. These repeated actions can gradually form ankle bone spurs (osteophytes) or create scar tissue. This abnormal tissue growth restricts ankle movement, intensifying pain and discomfort.

What Causes Anterior Ankle Impingement?

Sports are a primary cause of ankle injuries, with nearly 3 in 1000 people experiencing ankle sprains annually. One specific type of ankle pain, anterior ankle impingement, arises from several contributing factors. Let's explore these common causes:

Repetitive Ankle Motions

Activities involving frequent ankle dorsiflexion or pointing the foot upwards, can exert significant stress on the ankle joint. Athletes participating in sports that demand rapid changes in direction, jumping, and landing, including basketball, soccer, and dance, are particularly susceptible. Over time, this repetitive strain can lead to inflammation and damage to the joint tissues.

Bone Spurs (Osteophytes)

Chronic irritation and inflammation within the ankle joint can stimulate the growth of extra bone tissue, known as bone spurs. These bony protrusions can develop along the edges of the joint, reducing ankle mobility and exacerbating impingement symptoms.

Scar Tissue

Previous ankle injuries, such as sprains or fractures, can result in the formation of scar tissue within the joint. This fibrous tissue can restrict ankle movement and contribute to the development of anterior ankle impingement. Additionally, surgical procedures performed on the ankle can also lead to scar tissue formation.

Abnormal Foot Mechanics

Overpronation, a condition characterised by excessive inward rolling of the foot, can place abnormal stress on the ankle joint. This misalignment can contribute to the development of anterior ankle impingement by altering the foot's biomechanics and ankle complex.

Here's an additional note. When an ankle injury such as an ankle sprain causes chronic pain and worsens with specific movements, anterior impingement should be considered as a potential cause. Moreover, multiple ankle sprains or repetitive traumas can lead to anterior impingement syndrome.

Who Is At Risk?

Athletes are more prone to developing anterior ankle impingement, but other risk factors come into play. Conditions like rheumatoid arthritis and osteoarthritis can cause inflammation and degeneration of the ankle joint, increasing the likelihood of impingement. The following factors also increase the risks for every individual:

• Age. The natural ageing process contributes to cartilage degeneration and joint stiffness.
• Occupation. Certain professions involving repetitive ankle motions, such as athletes, dancers, construction workers, and factory workers, may be at higher risk.
• Footwear. Improperly fitting or supportive footwear can contribute to abnormal ankle mechanics and increase the risk of impingement.
• Obesity: Excess weight puts additional stress on the ankle joint, increasing the risk of inflammation and cartilage damage.
• Foot anatomy: Individuals with certain foot structures, such as flat feet or high arches, may be more prone to ankle impingement due to abnormal weight distribution.
• Genetics: A family history of ankle problems or joint-related conditions may increase susceptibility.

What Are The Symptoms?

The symptoms of anterior ankle impingement can vary in severity. The most common symptom is pain in the front of the ankle. This pain often worsens with activities that involve ankle dorsiflexion, such as:

• Walking uphill
• Climbing stairs
• Participating in sports that require sudden stops
• Sudden changes in direction

Inflammation in the ankle joint can lead to swelling, which may be noticeable around the front of the ankle. The ankle joint may feel stiff, particularly in the morning or after periods of inactivity. Additionally, you may experience difficulty moving the ankle freely, especially when pointing the toes upward.

In some cases, patients may experience a locking or catching sensation in the ankle joint, which can be painful and disruptive. In other severe situations, the ankle may feel unstable or give way, increasing the risk of further injury.

When left untreated, these symptoms may gradually worsen over time. The treatment approach for anterior ankle impingement depends on the severity of the condition and the individual's specific needs.

Conservative Treatments

Most cases of anterior ankle impingement work and heal well with non-surgical treatments. To treat anterior ankle impingement, keep up with the following management strategies.

RICE

This self-management approach involves:

• Rest: Avoiding activities that aggravate the ankle is crucial for reducing inflammation.
• Ice: Applying ice packs to the ankle can help reduce swelling and pain.
• Compression: Wearing a compression bandage can provide support and reduce swelling.
• Elevation: Elevating the ankle above heart level can help minimise swelling.

Over-the-counter (OTC) Medicines

Pain relievers and anti-inflammatories like ibuprofen or naproxen can help reduce pain and inflammation and speed up recovery.

Orthotics

Custom-made orthotics can help support the ankle and reduce stress on the affected area. These devices help cushion the impact of walking and running, reducing stress on the ankle. By providing additional support, orthotics can help stabilise the ankle joint, reducing the risk of further injury.

Orthopaedic Aids

This encompasses a variety of devices used to support, stabilise, or immobilise parts of the body, including items like splints, braces, and surgical dressings.

Physical Therapy

A skilled physical therapist can develop a customised programme to improve ankle strength, flexibility, and range of motion. This may include stretches, strengthening exercises, and balance training. Treatments like ankle fracture physiotherapy such as mobilisation techniques and soft tissue massage, can also be incorporated to address specific tissue restrictions.

Phoenix Rehab in Singapore provides ankle sprain treatment physiotherapy and solutions for other bone, muscle, joint, tendon pain and injuries, tailored to your specific needs. They also employ various therapeutic modalities to aid in pain management and tissue healing. These might include:

• Ultrasound: To reduce inflammation and promote tissue repair.
• Electrical stimulation: To manage pain and reduce muscle spasms.
• Taping and bracing: To provide support and stability to the ankle.

Working closely with a physical therapist helps people with anterior ankle impingement effectively manage their symptoms, improve function, and reduce the risk of recurrence.

Surgical Intervention

If conservative treatments fail to provide relief, your healthcare provider may recommend surgery. The goal of surgery is to remove the bone spurs or excess tissue to correct the impingement. This can be performed using arthroscopic surgery or open-surgical techniques. The decision to undergo surgery should be made in consultation with your doctor after carefully considering the potential risks and benefits.

Home Care and Prevention

Taking proactive steps to manage your anterior ankle pain and prevent further injury is essential. Here are some tips:

• Adhere to the treatment plan outlined by your doctor or physical therapist.
• Refrain from activities that put excessive stress on your ankle until it has healed.
• Incorporate warm-up exercises to increase blood flow to the ankles before engaging in physical activity.
• Cool-down exercises help relax the muscles and reduce stiffness.
• Building ankle strength through targeted exercises can help prevent future injuries.
• Maintain a healthy weight. Excess weight can put additional strain on your ankles.
• Pay attention to your surroundings to avoid tripping or falling, which can lead to ankle injuries.
• Wear protective taping or braces when still in the healing process to prevent the recurrence of injury.

Wrap Up

Anterior ankle pain is a common issue that can be caused by anterior ankle impingement. It's important to understand the symptoms, causes, and treatment options for this condition. Early diagnosis and appropriate treatment, such as physical therapy, can help manage pain and improve ankle function.

If you experience persistent ankle pain, swelling, or difficulty moving your ankle, consult with a healthcare professional for a proper diagnosis and personalised treatment plan. With appropriate care and attention, you can effectively manage anterior ankle impingement and return to the activities you love.