Anterior Ankle Impingement

What is Anterior Ankle Impingement

Anterior ankle impingement is a condition that causes pain and swelling in the front of the ankle.

What are the causes?

This condition may be caused by:

• Soft tissue getting caught between the shin bone (tibia) and the top ankle bone (talus).
• Extra bone (bone spur) on the tibia or talus.

This condition can develop due to:

• Repeated and forceful movement of your foot upward toward your shin.
• Repeated hits to the front of the ankle, such as from a soccer ball.
• Damage to the tough bands of tissue that connect bones together (ligaments).

What increases the risk?

This condition is more likely to develop in:

• People who sprain their ankle often.
• Athletes who take part in certain sports, including:
  • Soccer.
  • Football.
  • Gymnastics.
  • Ballet.
  • Running.

What are the signs or symptoms?

Symptoms of this condition include:

• Ankle pain that gets worse when you move your foot toward your shin and do certain activities, such as:
  • Going up stairs or a ladder.
  • Walking.
  • Running uphill.
  • Squatting.
• Pain when pushing on the front of the ankle (tenderness).
• Ankle swelling.
• Ankle stiffness.
• A feeling of getting stuck when you try to move your foot toward your shin.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam. During the exam, your health care provider will test for stiffness, tenderness, and pain.
• Imaging tests, such as:
  • An X-ray.
  • A CT scan. This may be done to check for bone damage.
  • MRI. This may be done to check for ligament damage.
  • An ultrasound. This may be done to check for soft tissue damage.

How is this treated?

Treatment for this condition may involve:

• Not using your ankle to support (bear) your body weight for several days.
• Wearing a removable boot, brace, or splint for ankle support.
• Using ice to reduce swelling.
• Taking anti-inflammatory pain medicine.
• Having medicines injected into your ankle joint to reduce pain and swelling.
• Doing exercises when pain and swelling improve.
• Using a heel lift.
• Returning to full activity gradually.
• Having surgery. Surgery is needed if there is a large or loose bone spur or if other treatments do not help. The surgery may be done to:
  • Remove bone spurs.
  • Enlarge the joint space.
  • Repair damaged ligaments.

Follow these instructions at home:

If you have a boot, brace, or splint:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen it if your toes tingle, become numb, or turn cold and blue.
• Keep it clean.
• If it is not waterproof:
  • Do notlet it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.
• Ask your health care provider when it is safe to drive with a boot, brace, or splint on your foot or leg.

Managing pain, stiffness, and swelling

• If directed, put ice on the injured area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Take over-the-counter and prescription medicines only as told by your health care provider.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do notput your full body weight on your ankle until your health care provider says that you can. Use crutches or a walker as told by your health care provider.
• Do notdo any activities that make pain or swelling worse.
• Do exercises as told by your health care provider.

General instructions

• Use a heel lift as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Wear supportive footwear that is appropriate for your athletic activity.
• Avoid athletic activities that cause ankle pain or swelling.
• Before you do any athletic activity, do ankle range-of-motion and strengthening exercises as told by your health care provider.
• If you start any new athletic activity, start gradually to build up your strength and flexibility.

Contact a health care provider if:

• You have ankle pain or swelling that is not getting better.
• You cannot put body weight on your foot without feeling pain.
• You have an ankle sprain that causes pain and swelling for more than 2–4 weeks.

Anterior Ankle Impingement Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse.  Do notbegin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your ankle. These exercises also help to relieve pain and stiffness.

Exercise A: Ankle alphabet

1. Sit with your left / right leg supported at the lower leg.
   • Do notrest your foot on anything.
   • Make sure your foot has room to move freely.
2. Think of your left / right foot as a paintbrush, and move your foot to trace each letter of the alphabet in the air. Keep your hip and knee still while you trace. Make the letters as large as you can without feeling discomfort.
3. Trace every letter from A to Z.

Repeat __________ times. Complete this exercise __________ times per day.

Strengthening exercises

These exercises build strength and endurance in your ankle. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Plantar flexors, eccentric

1. Stand on the balls of your feet on the edge of a step. The ball of your foot is on the walking surface, right under your toes.
   • Do notput your heels on the step.
   • Rest your hand on a railing for balance.
2. If told by your health care provider, put on a backpack to add weight.
3. Rise up onto your toes.
4. Keep your heels up while you slowly shift your body weight to your left / right foot.
5. Pick up your other foot.
6. Slowly lower your weight through your left / right foot so your heel drops below the level of the step. If this causes any pain at the front of your ankle, stop the motion early.
7. Put your other foot back on the step.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise C: Evertors

1. Sit on the floor with your legs straight out in front of you.
2. Loop a rubber exercise or band around the ball of your left / right foot. The ball of your foot is on the walking surface, right under your toes.
   • Hold the ends of the band in your hands, or secure the band to a stable object.
   • The band should be slightly tense when your foot is relaxed.
3. Slowly push your foot outward, away from your other leg.
4. Hold this position for __________ seconds.
5. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Balance exercises

These exercises improve or maintain your balance. Balance is important in improving ankle stability and preventing falls.

Exercise D: Single leg stand

1. Without shoes, stand near a railing or in a doorway. You may hold onto the railing or door frame if you need to.
2. Stand on your left / right foot. Keep your big toe down on the floor and try to keep your arch lifted.
3. Hold this position for ____ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

If this exercise is too easy, you can try it with your eyes closed or while standing on a pillow.

Exercise E: Inversion/eversion 1

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board from side to side as far as you can, alternating between tipping to the left and to the right. If you can, tip the board so it silently taps the floor. Do notlet the board forcefully hit the floor.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.

Exercise F: Inversion/eversion 2

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board from side to side, alternating between tipping to the left and to the right. Do notlet the board hit the floor at all.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.

Exercise G: Plantar flexion/dorsiflexion 1

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board forward and backward so the board silently taps the floor. Do notlet the board forcefully hit the floor.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.

Exercise H: Plantar flexion/dorsiflexion 2

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board forward and backward. Do notlet the board hit the floor at all.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.