What is anterior ankle impingement?
Anterior ankle impingement, also known as anterior impingement syndrome, is the medical term used when repetitive compressive forces cause damage to the soft tissue at the front of the ankle. The ankle joint is made up of one strong capsule that forms around the joint, enclosing it and preventing either boney ends of the lower leg and foot from connecting or impacting. The ankle is in fact made of two joints in order to allow it a lot of movement and flexibility. The point where the lower leg connects to the foot is through the tibiotalar joint (the joint between the tibia and the talus), this joint allows the foot to point downwards and upwards. Pointing upwards is known as dorsiflexion; it compresses the ankle at the front and is the action responsible for most anterior ankle impingements. The second joint is the subtalar joint (the joint between the talus and calcaneus), this joint allows the ankle to bend from side to side. The two joints are encompassed by the one strong capsule. The capsule itself is filled with a small amount of thick fluid called synovial fluid which acts like a cushion and there is also a protective layer of articular cartilage that covers each boney surface. The cartilage, fluid and strong capsule allow the joint to move in a smooth, flexible manner. Ligaments that surround the joint are made of thick, tough, fibrous tissue; they overlap the joint and work in co-ordination with the strong lower leg muscles to provide protection and stability for the ankle. So as you can see there are a lot of soft tissue structures at the front of the ankle that may be injured.
Why & when does anterior ankle impingement happen?
Anterior ankle impingement is a common injury and effects people of all ages; however it is normally seen in individuals who partake in athletic sports that involve repetitive or forceful dorsiflexion of the foot, for example running, particularly sprinting and uphill or downhill running and landing from long jump. The forceful and repetitive compression at the front of the ankle between the boney surfaces of the tibia and talus entraps the soft tissue of the ankle joint. This causes small amounts of damage to and inflammation of those structures with each compression. Certain anatomical variants or dysfunction with the foot or ankle joint may leave you slightly more at risk of developing anterior impingement syndrome, as does hypermobile ankles. Often cases of ankle impingement are seen after an acute injury to the ankle, such as an ankle sprain.
What does anterior ankle impingement feel like?
Anterior ankle impingement can cause an intense immediate sharp pain or dull ache around the front of the ankle during dorsiflexion of your foot. In some cases the discomfort is only felt on dorsiflexion or even just weight bearing during an activity and with others it is felt once resting after such an activity. Stiffness and dull aches are normally experienced during the night and are most intense early in the morning. The pain and discomfort is not always restricted to the front of the ankle and is often reported to radiate up into the shin or down into the foot. On occasion, there may be minor swelling around the front of the ankle; this is normally only experienced after a long period or repetitive dorsiflexion.
How long does anterior ankle impingement take to heal?
Mild cases of anterior ankle impingement can recover in as little as one to two weeks, whilst more moderate or severe ankle impingements take longer. As long as the aggravating dorsiflexion activity has been avoided during recovery then most impingements will have fully healed within six weeks. If you experience pain for longer than six weeks it is advisable to attend your GP.
How will anterior ankle impingement be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. Occasionally an ankle X-ray or further investigation may be needed to confirm diagnosis and rule out any complicating factors.
What treatment options are available for anterior ankle impingement?
Your GP will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. You will be advised to follow the R.I.C.E protocol. The R.I.C.E protocol involves resting your ankle, trying not to walk about on it too much and most importantly avoiding all dorsiflexion movements. Ice, applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and make sure to take it off at night. Elevation, keep your foot raised on cushions or a stool to help limit the swelling.
Your GP or therapist will be able to provide you with exercises to strengthen the ankle ligaments and muscles to aid the healing process and prevent reoccurring injury. Many people find manipulative therapies such as physiotherapy, chiropractic and osteopathy help through mobilisation treatment of the ankle as it works to reduce the severe stiffness levels and return the joint back to its normal movement.
If you feel or your GP has mentioned that there is any foot or ankle dysfunction that has predisposed you to this injury then it is very important that you see a Podiatrist who can fully check whether or not your foot needs extra support through orthotics for your shoes. The failure to do this may result in recurring cases of ankle impingement.