Ankle Impingement

What is ankle impingement?

An ankle impingement happens when the bones or soft tissue in the ankle is squeezed together by the ankle bones. This causes ankle pain or limits how the ankle moves. Ankle impingement is usually a serious, long-term injury from using the ankle joint too much. It can be caused by a sudden injury though.

There are two types of ankle impingement injuries:

• Anterior ankle impingement (front of the ankle)
• Posterior ankle impingement (back of the ankle)

Anterior ankle impingement (front of the ankle injury) is caused by constantly moving the foot upwards. This upward movement is called dorsiflexion. This injury is seen in sports such as football and basketball where ankle sprains are common. 

Posterior ankle impingement (back of the ankle injury) is caused by constantly pointing the toes down. This downward movement is called plantar flexion. This injury is seen in sports such as dancing (ballet), gymnastics and soccer.  

How do you diagnose ankle impingement?

The provider will ask how and when the injury happened, and when the pain started. A physical exam of the patient will look for:

• Problems when walking
• Abnormal ankle shape
• Swollen joints
• Tenderness or pain
• How well the ankle can move

Tests:

X-rays: This is the common way to see if there is an ankle impingement.  Bones may be out of place on the front or the back of the ankle.

MRI (Magnetic Resonance Imaging): A provider can use this type of scan for detailed information on the ankle injury.

What is the treatment for ankle impingement?

• Treatment for both front and back ankle impingement includes:
• Rest from activities
• Physical therapy or exercises at home
• Ice
• Anti-inflammatory medications like ibuprofen
• A cast or a walking boot to control ankle movement

Surgery may be necessary if pain or symptoms do not stop other treatments have been tried. An orthopedic surgeon removes the soft tissue or bone parts causing the pain and symptoms.

After surgery, physical therapy or exercises at home help rebuild how much the ankle can move and its strength. It usually takes 4 to 6 weeks to heal before returning to sports and other activities after surgery.

For more information on Posterior Ankle Impingement:

Sarah's story: Flipping her way back into the gym

Posterior ankle impingement – an underdiagnosed cause of ankle pain in pediatric patients