Anterior ankle impingement (footballer's ankle) is a painful pinching or compression of either the soft or the bony tissue at the front of your ankle joint. It happens when the tissue of the joint swells from repetitive motion and stretches beyond its maximum point. As a result, the ligaments thicken and get caught between your lower leg bone (tibia) and upper foot (talus). As a natural response, your body starts to build up extra bone tissue called bone spurs (osteophytes) in the injured area.
Because this type of ankle impingement most commonly affects soccer players, it's known colloquially as footballer's ankle. These athletes engage in repetitive motions using their legs, ankles, and feet. Repeating these same ankle motions over and over causes small traumas, which eventually result in more serious injuries.
What's the Impact of Anterior Ankle Impingement on Your Health?
People who have anterior ankle impingement may report chronic pain, which makes it more difficult for them to get back into sports and other activities they may have once enjoyed regularly.
Because regular activity is part of healthy living and helps reduce stress and anxiety, people with anterior ankle impingement may be more likely to experience these negative feelings. However, with the right treatment plan and extensive physical therapy, you can slowly get back to enjoying some of the activities you love.
What Causes Anterior Ankle Impingement?
Footballer's ankle is caused by any activity that requires repetitive and forced dorsiflexion in your ankle — in other words, pointing your foot upward.
Aside from playing soccer, these activities include:
- Any other activity that commonly causes ankle sprains
You're more likely to get anterior ankle impingement from spraining your ankle badly or multiple times. This is because each time you do, your ligaments stretch and become weaker. These stretched ligaments can no longer tell your brain how to move your ankle, which means you become less coordinated when it comes to using this part of your body. People with arthritis are also at increased risk for anterior ankle impingement.
Those with preexisting ankle damage and inflammation from frequent sprains in the same ankle are at greater risk of anterior impingement syndrome (AIS), which is a chronic disorder.
What Are the Symptoms of Anterior Ankle Impingement?
The symptoms of anterior ankle impingement vary from person to person, but the following are common ones:
- Pain on the front-outside (anterior) part of your ankle
- Continued pain even after your ankle has healed
- Weakness or feeling unstable in your ankle(s)
- Pain lifting your foot up
- Pain when using stairs. walking or running uphill, or squatting low
- Less range of motion when stretching your toes upward
- Pain stretching your toes closer to your shins
- Feeling tenderness when you touch your ankle
How Do You Diagnose Anterior Ankle Impingement?
To diagnose anterior ankle impingement, your healthcare provider will likely do a clinical evaluation. Through this evaluation, they can review your medical history and figure out the cause of the impingement, whether it's repeated ankle sprains, arthritis, or something else. Your doctor will also likely do some form of physical exam to test your range of motion, balance, and overall functionality of your ankle.
More specifically, your doctor will look for any of the following:
- Trouble walking
- Unusual ankle shape
- Swelling in your joints
- Pain or tenderness in your ankle
- How well you can move your ankle
Depending on what your doctor finds out from the clinical evaluation, they may have you go through a few imaging tests. These might include:
How Do You Treat Anterior Ankle Impingement?
Anterior ankle impingement can be a burden to your overall well-being. Luckily, there are many treatment options to help you go back to your normal activities. Your doctor can advise you on what type of treatment would work best depending on the extent of your injury and your other individual needs.
Some common non-surgical treatment options include:
- Over-the-counter anti-inflammatories like ibuprofen to reduce pain and help speed up the healing process
- Icing the ankle to reduce swelling and inflammation
- A cast or brace, or an alternative everyday shoe that better supports your ankle and controls movement
- Physical therapy to help improve your range of motion, break down bone spurs, and restore overall ankle function
- Occasional steroid injections into the ankle joint, which may help if you also have ankle arthritis
- Plenty of rest
If the above treatment options don't work, your doctor may recommend surgery to remove the scar tissue or bone spurs causing the impingement.
The two most common surgical treatment options are:
This is a type of surgery where your doctor makes an incision directly in your ankle to remove the spur. When the bone spurs are large, this is usually the easiest and quickest option.
Statistics show that this form of surgery has a 67% to 88% success rate among patients.
Through arthroscopic surgery, your doctor uses a thin fiber-optic camera (arthroscope) to view your impinged ankle on a computer screen. With a magnified view, they can then shave off any inflamed tissues and bone spurs that might be smaller and more difficult to remove through incision.