Anterior Ankle Impingement Syndrome

Anterior ankle impingement syndrome is a condition that occurs when bone spurs form in the front of the ankle joint. The bone spurs can either form on the end of the shin bone (the tibia), on top of the ankle bone (the talus), or on both. When the foot is pushed upwards, the bone spurs pinch, causing pain over the front of the ankle.

Who Is at Risk

Anterior ankle impingement syndrome has often been referred to as "athlete's ankle" or "footballer's ankle." The condition is thought to be the result of repetitive microtrauma (overuse injury) to the ankle, although it has other possible causes, including ankle sprain.

This injury is common in athletes and artists whose crafts require repetitive ankle dorsiflexion—raising the foot upward at the ankle. That includes:

• Soccer players, who also sustain many blows from the ball and other players at the ankle
• Football players
• Ballet dancers
• Runners
• Gymnasts

Bone spurs and osteophytes may show up on X-rays for some athletes who have no symptoms.

Symptoms

Typically, people with anterior ankle impingement have pain over the front of the ankle joint, especially when the foot is pushed upwards towards the shin (dorsiflexion). This area is often tender, and occasionally the bone spur can be felt over the front of the ankle.

The pain is often relieved when the ankle is allowed to plantarflex (like when your toe is pointed or your foot is in a relaxed position.)

Repeated ankle sprains are another symptom. You may notice that your ankle is swollen after activity.

Diagnosis

Healthcare providers typical diagnose anterior ankle impingement with a physical exam and an X-ray.

Other imaging tests, such as an MRI, ultrasound (especially for soft-tissue impingement, or CT scan, may be used to confirm the diagnosis and to check for other problems in the ankle joint that could be causing your pain.

Treatment

The usual treatment of anterior ankle impingement syndrome is aimed at decreasing inflammation at the site of the impingement. This can be accomplished with:

• Rest
• Oral anti-inflammatory medications
• Ice applications
• Heel wedges in shoes
• An ankle brace
• Possibly, cortisone injection

An ankle brace may be especially considered if you've had repeated ankle sprains. Your healthcare provider may prescribe orthotics to correct foot alignment, if necessary.

Surgical Procedures

If these treatments are not successful, your healthcare provider may recommend surgery.

In a surgical procedure called arthroscopic debridement, the surgeon makes small incisions and uses a mirror to see inside your ankle to remove the bone spurs causing the impingement.

For large osteophytes, a surgical procedure called open debridement, which involves a larger incision, may be recommended. This surgery must be done carefully to ensure there isn't damage to the artery or the deep peroneal nerve in this area of the ankle.

Arthroscopic debridement of bony and soft tissue impingements has had a good success rate, a shorter recovery time, and a faster return to sports activities compared with open debridement surgery. Research suggests most people have good pain relief after arthroscopic surgery, but only about a quarter of those studied could return to their previous level of athletic ability within two years of the procedure.

After surgery, expect to wear a walking boot for two weeks, followed by physical therapy to restore range of motion, build strength, and improve endurance. If all goes well, you'll likely be allowed to return to sports after six to eight weeks.