Anterior Ankle Impingement

with Rehab

An impingement is a pinching of bone or tissue. The front (anterior) of the ankle is an area of the body that is susceptible to impingement. Anterior ankle impingements may be caused by either an acute injury or repetitive injury. Often, ankle impingement occurs after a previous ankle injury, such as an ankle sprain. The injured tissue scars and becomes caught between two bones, usually the shinbone (tibia) and the bones of the upper foot (talus bones). Anterior ankle impingement may also be caused by bone spurs at the front of the lower end of the tibia that pushes against other tissues. The pressure on the surrounding tissue causes pain and inflammation. The swelling of the tissue often causes the impaction to become worse and causes even more pain.

SYMPTOMS

  • Pain with bringing the foot towards the shin (flexion).

  • Loss of ability to push off or drive (the ability to run forcefully) or inability to run, cut, or jump at full speed.

  • Swelling (occasionally).

  • Locking of the joint (rarely).

CAUSES

Anterior ankle impingement is caused by tissue (bone or soft tissue) being pinched by other structures in the ankle, such as two bones or a bone spur. Anterior ankle impingement may be caused by acute or repetitive injury.

RISK INCREASES WITH:

  • Sports that require repetitive or forceful extension (pushing the foot downward) of the ankle (sprinting or jumping).

  • Repeated injuries to the foot or ankle.

  • Poor ankle strength and flexibility.

  • Failure to warm-up properly before activity.

PREVENTION

  • Warm-up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength.

  • Flexibility.

  • Cardiovascular fitness.

  • Learn and use proper technique.

  • Wear proper protective taping or bracing to prevent ankle hyperextension or repeated injury.

  • Allow complete recovery after an ankle or foot injury before returning to any sport that requires ankle extension.

PROGNOSIS

If treated properly, anterior ankle impingement is usually curable with nonsurgical (conservative) treatment. However, sometimes surgery is necessary in order to alleviate the negative symptoms.

RELATED COMPLICATIONS

  • Frequent recurrence of symptoms, which may result in chronically inflamed tissue and eventually a chronic problem.

  • Disability severe enough to diminish an athlete's competitive ability.

  • Arthritis of the ankle.

TREATMENT

Treatment initially consists of ice and medicine to help reduce pain and inflammation. Wearing an elastic compression bandage, as well as performing strengthening and stretching exercises may also help reduce the negative symptoms. These exercises may be done at home or with a therapist. Your caregiver may choose to give you an ankle brace to reduce the movement of the ankle. This may help reduce inflammation and pain. If symptoms persist despite conservative treatment, surgery may be necessary. Surgery usually involves using arthroscopic methods to remove the bone spur, inflamed tissue, or scar tissue.

MEDICATION

  • If pain medicine is necessary, nonsteroidal anti-inflammatory medicines such as aspirin and ibuprofen or other minor pain relievers such as acetaminophen are often recommended.

  • Do not take pain medicine within 7 days before surgery.

  • Prescription pain relievers may be given to you by your caregiver. Use only as directed and only as much as you need.

  • Ointments applied to the skin may be helpful.

  • Corticosteroid injections may be given to help reduce inflammation. However, corticosteroid injections are only used for severe cases.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

SEEK MEDICAL CARE IF:

  • Your symptoms get worse or do not improve in 2 weeks despite treatment.

  • You experience any of the following after surgery:

  • Pain, numbness, or coldness in the foot and ankle.

  • Blue, gray, or dusky color in the toenails.

  • Increased pain, swelling, redness, drainage, or bleeding in the surgical area.

  • You have signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever).

  • You develop new, unexplained symptoms. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES — Anterior Ankle Impingement

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist, or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

STRETCH — Gastrocnemius, Standing

  • Place hands on wall.

  • Extend right / left leg and place a folded washcloth under the arch of your foot for support. Keep the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keeping your right / left heel on the floor and your knee straight, shift your weight toward the wall, not allowing your back to arch.

  • You should feel a gentle stretch in the calf. Hold this position for __________ seconds.

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

STRETCH — Soleus, Standing

  • Place hands on wall.

  • Extend right / left leg and place a folded washcloth under the arch of your foot for support. Keep the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keep your right / left heel on the floor, bend your back knee, and slightly shift your weight over the back leg so that you feel a gentle stretch deep in your back calf.

  • Hold this position for __________ seconds.

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

RANGE OF MOTION — Ankle Plantar Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Use your opposite hand to pull the top of your foot and toes toward you.

  • You should feel a gentle stretch on the top of your foot or ankle. Hold this position for __________ seconds.

Repeat __________ times. Complete __________ times per day.

RANGE OF MOTION — Ankle Eversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the top of your foot and your fingers across the bottom of your foot.

  • Gently push your foot downward with a slight rotation so your littlest toes rise slightly.

  • You should feel a gentle stretch on the inside of your ankle. Hold the stretch for __________ seconds.

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

RANGE OF MOTION — Ankle Inversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the bottom of your foot and your fingers across the top of your foot.

  • Gently pull your foot so the smallest toe comes toward you and your thumb pushes the inside of the ball of your foot away from you.

  • You should feel a gentle stretch on the outside of your ankle. Hold the stretch for __________ seconds.

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

STRENGTHENING EXERCISES — Anterior Ankle Impingement

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist, or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist, or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH — Dorsiflexors

  • Secure a rubber exercise band or tubing to a fixed object (such as a table, pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band or tubing should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

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

STRENGTH — Ankle Eversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Drawing the band or tubing across your opposite foot, slowly, pull your little toe out and up. Make sure the band or tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band or tubing as it slowly pulls your foot back to the starting position.

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

STRENGTH — Ankle Inversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band or tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band or tubing as it slowly pulls your foot back to the starting position.

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

STRENGTH — Plantar-flexors, Eccentric

Note: This exercise can place a lot of stress on your foot and ankle. Please complete this exercise only if specifically instructed by your caregiver.

  • Place the balls of your feet on a step. With your hands, use only enough support from a wall or rail to keep your balance.

  • Keep your knees straight and rise up on your toes.

  • Slowly shift your weight entirely to your right / left toes and pick up your opposite foot. Gently and with controlled movement, lower your weight through your right / left foot so that your heel drops below the level of the step. You will feel a slight stretch in the back of your calf at the ending position.

  • Use the healthy leg to help rise up onto the balls of both feet, then lower weight only on the right / left leg again. Build up to 15 repetitions. Then progress to 3 consecutive sets of 15 repetitions.*

  • After completing the above exercise, complete the same exercise with a slight knee bend (about 30 degrees). Again, build up to 15 repetitions. Then progress to 3 consecutive sets of 15 repetitions.*

Perform this exercise __________ times per day.

*When you easily complete 3 sets of 15, your physician, physical therapist, or athletic trainer may advise you to add resistance by wearing a backpack filled with additional weight.

BALANCE — Inversion/Eversion

Use caution, these are advanced level exercises. Do not begin them until you are advised to do so.

  • Create a balance board using a sturdy board about 1½ feet (40 cm) long and 1-1½ feet (30-40 cm) wide and a 1½ inch (3 cm) diameter rod or pipe that is as long as the board's width. A copper pipe or a solid broomstick work well.

  • Stand on a non-carpeted surface near a countertop or wall. Step onto the board so that your feet are hip-width apart and equally straddle the rod or pipe.

  • Keeping your feet in place, complete these two exercises without shifting your upper body or hips:

  • Tip the board from side-to-side. Control the movement so the board does not forcefully strike the ground. The board should silently tap the ground.

  • Tip the board side-to-side without striking the ground. Occasionally pause and maintain a steady position at various points.

  • Repeat the first two exercises, but use only your right / left foot. Place your right / left foot directly over the rod or pipe.

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

BALANCE — Plantar/Dorsi Flexion

Use caution, these are advanced level exercises. Do not begin them until you are advised to do so.

  • Create a balance board using a sturdy board about 1½ feet (40 cm) long and 1-1½ feet (30-40 cm) wide and a 1½ inch (3 cm) diameter rod or pipe that is as long as the board's width. A copper pipe or a solid broomstick work well.

  • Stand on a non-carpeted surface near a countertop or wall. Stand on the board so that the rod or pipe runs under the arches in your feet.

  • Keeping your feet in place, complete these two exercises without shifting your upper body or hips:

  • Tip the board from side-to-side. Control the movement so the board does not forcefully strike the ground. The board should silently tap the ground.

  • Tip the board side-to-side without striking the ground. Occasionally pause and maintain a steady position at various points.

  • Repeat the first two exercises, but use only your right / left foot. Stand in the center of the board.

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