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Ankle Impingement Syndrome - Types, Symptoms, Diagnosis and Treatment

Published on Oct 28, 2022   -  4 min read


Due to a bony or soft-tissue defect, ankle impingement syndrome causes a painful mechanical limitation of the full ankle range of motion.

What Is Ankle Impingement Syndrome?

Ankle impingement is a term that refers to a set of anterior and posterior joint pathologies that include both bone and soft tissue problems. The most common type of impingement is known as a footballer's ankle. Soccer, football, basketball, and dancing are common sports where this condition might occur.

What Are the Types of Ankle Impingement Syndrome?

Impingement syndromes in the ankle cover a wide range of conditions with different etiologies, anatomic characteristics, and symptoms. These syndromes are commonly defined by the anatomic area implicated, despite the lack of a formal categorization. There have been descriptions of specific anterior, anterolateral, anteromedial, posterior, posteromedial, posterolateral, and syndesmotic impingements.

These disorders are divided into:

  • Anterior ankle impingement.

  • Posterior ankle impingement.

The pain on the front side of your ankle is known as anterior ankle impingement. Repetitive stressors in end-range positions of the ankle, such as when jumping, squatting, or descending stairs, cause inflammation and swelling. Bone spurs in the ankle joint space may form as a result of this. Ankle instability is another cause of anterior ankle impingement. Ankle instability is the loosening of the ankle joint, which is caused by recurrent ankle sprains that weaken the ankle ligaments. The ligaments may scar and take up more joint space as a result of this damage. When tissue in the joint area is squeezed, it causes pain during activities that require ankle dorsiflexion, which is extending your toes up toward your shin. Squatting, jumping, and stair-climbing are some examples of these activities.

Pain on the backside of your ankle, particularly when pointing your toes, is a sign of posterior ankle impingement. Compression of soft or bony tissue which is present between the shin bone (tibia) and the heel bone causes pain. The Os Trigonum is a little additional bone in the back of the ankle that some people have. When the foot is pointed, this little bone might produce posterior impingement due to compression between the shin bone and the heel bone.

What Are the Signs and Symptoms of Ankle Impingement Syndrome?

With anterior ankle impingement, you may have the following symptoms:

  • Pain on the front side or outside of the ankle joint.

  • Reduced ankle range of motion when stretching your toes up toward your tibial bone.

  • Tenderness or softness at the front of the ankle when touched.

  • A feeling of ankle instability.

  • Pain at the end range of stretching your toes toward your shin.

With posterior ankle impingement, you may have the following symptoms:

  • Pain on the backside of your ankle, especially during activities that involve pointing or targeting toes.

  • Tenderness on the backside of the ankle when touched.

  • Reduced range of motion when pointing your toes.

How Is Ankle Impingement Syndrome Diagnosed?

  • Standard radiographs.

  • A diagnostic injection is a local anesthetic administered into a joint capsule and soft tissue. If the injection relieves the symptoms, then it is a positive test.

  • MRI for soft tissue swelling and extent of the injury

How Long Does Ankle Impingement Take To Heal?

Returning to activity or sport is dependent on the person, although athletes with minor injuries can return in four to six weeks. The duration of time it takes to recover from an ankle impingement varies greatly depending on the severity of the injury. The pain may take longer to relieve, but this should not affect your ability to conduct sport-specific exercises prior to your return. In severe circumstances, recovery may take longer.

Does Ankle Impingement Get Worse?

If not addressed, they usually get worse as the season progresses, to the point where the player trains and plays less. Anterior Ankle Impingement, squeezing of the ligamentous capsule at the front of the ankle, is a common cause of this condition.

What Are the Treatment Options For Ankle Impingement Syndrome?

Nonsurgical Treatment:

Despite minimal evidence of efficacy, nonsurgical therapy remains the first line of treatment for both anterior and posterior impingement disorders. A period of rest and avoidance of stimulating activities is indicated for acute symptoms. In more severe situations, this therapy can be reinforced with ice, NSAIDs, or cast immobilization. In extreme situations, rest might be augmented with ice, NSAIDs, or immobility. Shoe modifications, such as heel lift orthoses to prevent dorsiflexion, have been used in chronic cases. The main target of physical therapy is to improve ankle stability and improve proprioception. Authors have reported that ultrasound-guided corticosteroid injections, which may also be used for diagnostic purposes, have provided effective symptom relief. After an inversion sprain of the ankle, patients should be treated conservatively for at least six months. After an ankle inversion injury, they should be treated conservatively with proper joint rehabilitation, peroneal strengthening, and muscle balance. Patients who do not respond to conservative treatment may need to have surgery.

Surgical Treatment:

Surgical intervention is usually recommended when symptoms continue despite non-operative treatment, have an impact on everyday activities or athletic performance, and are associated with physical exams and imaging findings. The surgical method and technique differ depending on the anatomical location and disease. Debridement, osteophyte removal, meniscoid lesion excision, partial capsulectomy, flexor hallux longus release, and tibia chondroplasty are some of the surgical options.

Physical Therapy Management:

You must consult with a physical therapist who specializes in treating ankle impingement. Some physical therapists specialize in both orthopedics and sports medicine. A physical therapist who has completed a residency or fellowship in orthopedic or sports physical therapy or who is a board-certified clinical specialist has extensive knowledge, expertise, and abilities that may be useful in treating your condition.

How Can Ankle Impingement Syndrome Be Prevented?

Active and at-risk adults can, however, take some steps to reduce the risk of ankle impingement, such as:

  • When performing physical activities, use proper technique.

  • Avoiding overtraining; repetitive stress is a common cause of conditions like ankle impingement.

  • Wearing appropriate footwear while participating in sports in accordance with the regulations of the game.


The proper diagnosis of the condition is supported by a thorough history, physical examination, imaging studies, and diagnostic injections. Many patients will benefit from non-operative therapy options, but open and arthroscopic procedures have evolved to manage chronic issues with successful and consistent results.

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Last reviewed at:
28 Oct 2022  -  4 min read




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