Ankle Impingement

The ankle is made up of many bones, muscles and ligaments that aid in the smooth movement of the foot. Ankle impingement is the painful limitation of movement of the ankle due to an abnormality in the soft tissue or bone.

Impingement can occur in the front (anterior ankle impingement) or back (posterior ankle impingement) of the ankle.

• Anterior ankle impingement is seen in athletes whose actions involve repeated upward bending of the ankle. This causes irritation at the front edge, which in time can lead to impingement.Other causes may include excess scar tissue formed with the healing of an ankle sprain (stretched or torn ligament)or bone spurs formed due to continuous wear and tear of the bone.
• Posterior ankle impingement is usually seen in ballet dancers who repeatedly stand on their toes. This causes tissues to get sandwiched and pinched between the tibia (lower leg bone) and heel bone leading to ankle impingement. Posterior ankle impingement is a relatively rare occurrence.

Symptoms of ankle impingement include pain and swelling along the front and back of the ankle,which increases with movement. There may be also a painful clicking sensation when the foot is twisted inwards and outwards.

Your doctor will usually be able to diagnose the condition by moving the ankle through its full range of motion. The point of maximum tenderness is usually where the tissues are being pinched. This is confirmed by injecting a numbing agent to see if relief is achieved. X-rays and bone scans may also be ordered.

Treatment may involve resting the ankle, use of ice packs to reduce swelling, placing the ankle in a cast or special boot to restrict movement, pain medications, physical therapy,and steroid injections into the painful area to promote faster healing. In case symptoms persist surgical treatment may be required, which involves excision of excess scar tissue, damaged tissue, bone spurs or other abnormalities through a minimally invasive procedure. Following treatment, a period of physical therapy rehabilitation is recommended to regain strength and flexibility of the joint.