Ankle Impingement

Pathophysiology

Ankle impingement can occur for multiple reasons, often this is either bony (e.g. due to osteoarthritis) or soft tissue (e.g muscular imbalance). It is more common in footballers, dancers and those who repetitively load their ankles. It can be at the front (anterior) or back (posterior) of the ankle.

Symptoms

  • Dull ache at the front of the ankle, can become sharp with excessive movement or weight-bearing
  • Tender to press around the front of the joint
  • Stiffness or blocking feeling at end range (bring toes towards body)
  • Swelling of the ankle
  • Pain worse with running, jumping and deep squats

Management

  • Activity modification
  • Ice or heat
  • Pain relief
  • Appropriate footwear which provides support and doesn’t rub on the tendon
  • Orthotics
  • Physiotherapy including range of movement exercises and a graded strengthening programme
  • Orthopaedic options - If pain and functional limitation is significant after 6 months conservative measures may be considered

Investigations

  • Generally not indicated

Exercises to try:

Impingement

Single Leg Stand Exercise

Holding on if needed

Stand on one leg and try to maintain your balance for 30-60 seconds 

calf

Standing Calf Raise Exercise

Holding onto the wall if necessary

Rise up onto your tiptoes (keeping your legs straight) before slowly (5 seconds) lowering down

stretcg

Calf Stretch Exercise 

Standing with both hands shoulder width apart on a wall

Step one foot back behind the other

Push forwards into the wall with the front knee bent

Keep the back leg straight and heel flat on the floor

Hold for 30 seconds

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