Ankle impingement is a condition that can cause persistent pain and limited movement in the ankle joint. It occurs when structures within the ankle get “pinched” or compressed during movement.
What Ankle Impingement Is
Ankle impingement describes a condition where soft tissues or bones within the ankle joint are compressed when the ankle moves through its range of motion. The ankle joint, formed by the tibia, fibula, and talus, relies on smooth movement between these structures.
When impingement occurs, bones or surrounding soft tissues like ligaments, joint capsule, or scar tissue can become trapped, leading to inflammation, pain, and structural changes. Understanding this mechanism explains why certain movements or activities might worsen symptoms.
Types of Ankle Impingement
Ankle impingement is categorized based on the specific anatomical location where the compression occurs. The most frequently observed types include anterior (front), posterior (back), and anterolateral (front-outer side) impingement, each affecting different parts of the joint.
Anterior ankle impingement affects the front of the ankle joint. It typically involves the compression of soft tissues or bone spurs on the tibia or talus, which then pinch during activities like squatting or running downhill. This type often causes pain when the foot is maximally pointed upwards (dorsiflexion).
Posterior ankle impingement occurs at the back of the ankle. It often involves soft tissue entrapment, such as the posterior capsule or the os trigonum, or bone spurs from the tibia or talus. Pain typically arises during activities that involve pointing the foot downwards (plantarflexion).
Anterolateral ankle impingement affects the front and outer side of the ankle. This type commonly results from scar tissue formation or synovitis following an ankle sprain. The compressed tissue causes pain and tenderness, especially when the ankle is moved into a position that combines upward pointing and outward turning.
Common Symptoms
Individuals experiencing ankle impingement often report a range of symptoms, primarily centered around pain and restricted movement. Certain signs are consistently observed across different types of impingement.
Localized pain is a primary symptom, and it typically worsens with specific ankle movements or activities that trigger the impingement. Swelling around the affected area of the ankle is also common, indicating inflammation within the joint.
Tenderness over the impinged area is common. Some individuals might also hear or feel clicking or popping sounds during ankle movement. Instability or weakness in the ankle, along with a reduced range of motion, can also occur.
What Causes Ankle Impingement
Ankle impingement develops due to various factors that lead to the compression of structures within the joint. These underlying reasons often involve repetitive stress, previous injuries, or the development of abnormal bony growths.
Repetitive microtrauma, often seen in athletes, is a common cause. Sports involving frequent and extreme ankle movements can repeatedly stress the ankle joint. This constant impingement can lead to inflammation and the formation of scar tissue or bone spurs over time.
Previous ankle sprains are another significant contributor, especially to anterolateral impingement. An initial sprain might not heal completely, leading to the formation of fibrous scar tissue within the joint. This scar tissue can then become entrapped and pinched during normal ankle movements, causing chronic pain.
The development of bone spurs, also known as osteophytes, is a frequent cause of both anterior and posterior impingement. These bony growths can form on the edges of the tibia or talus due to chronic irritation or osteoarthritis. When these spurs grow large enough, they can mechanically block normal ankle movement and pinch surrounding tissues. Thickening of the joint capsule can also contribute to impingement by reducing joint space and making tissues more prone to compression.
How It’s Diagnosed and Treated
Diagnosing ankle impingement typically involves a combination of a thorough physical examination, a detailed review of the patient’s history, and various imaging studies. The diagnostic process aims to confirm the presence of impingement and rule out other potential causes of ankle pain.
During a physical examination, a doctor will assess the ankle’s range of motion, identify areas of tenderness, and perform specific movements that reproduce the patient’s pain, indicating where the impingement occurs. Imaging studies are important; X-rays can reveal bone spurs, particularly in anterior and posterior impingement. Magnetic Resonance Imaging (MRI) provides detailed images of soft tissues, helping to visualize scar tissue, inflamed synovium, or cartilage damage that might be contributing to the impingement.
Treatment for ankle impingement typically begins with conservative approaches, aiming to reduce pain and inflammation without surgery. Rest from aggravating activities, applying ice to the affected area, and using non-steroidal anti-inflammatory drugs (NSAIDs) can help manage initial symptoms. Physical therapy is a key part of conservative treatment, focusing on strengthening ankle muscles, improving flexibility, and restoring proprioception (the body’s sense of position and movement). Bracing or taping can provide additional support, and corticosteroid injections directly into the joint may offer temporary pain relief and reduce inflammation.
If conservative treatments do not provide sufficient relief, surgical intervention may be considered. Arthroscopic surgery is a common and minimally invasive procedure used to treat ankle impingement. During this procedure, a surgeon makes small incisions to insert a tiny camera and specialized instruments into the joint. They can then remove impinged tissue, excise bone spurs, or address other structural issues causing the compression. This surgical approach aims to restore normal ankle mechanics and alleviate chronic pain.