A Guide to Physical Therapy for Ankle Impingement

Is ankle pain keeping you from an active lifestyle? There are many causes for ankle pain, and ankle impingement is one of them.

Ankle pain can make it hard to enjoy normal daily activities and sports,like navigating stairs, standing, and kicking a ball. Ankle impingement tends to be a result of cumulative stress, which can also lead to a lot of frustration and loss of quality of life.

Ankle impingement is most common in athletes participating in sports like soccer and football. It can contribute to extra time on the sidelines. Ankle impingement does not have to permanently keep you on the sidelines with the guidance of a CityPT clinician. Keep reading to learn more about how to effectively manage symptoms of ankle impingement.

Table of Contents

• Understanding Ankle Impingement
• Symptoms of Ankle Impingement
• What are the Most Common Causes of Ankle Impingement?
• Diagnosing Ankle Impingement
• What to Expect from Physical Therapy
• What If Conservative Treatment Doesn't Work?
• How Can I Prevent Ankle Impingement?
• Is It Time to Seek Treatment?

Understanding Ankle Impingement

Ankle impingement is a common cause of ankle pain, especially in active individuals. Impingement is a term used to describe an injury where structures become entrapped or pinched, leading to pain and limitations in movement.

There are two types of ankle impingement: anterior ankle impingement and posterior ankle impingement.

Ankle anatomy

The main bones that make up the ankle include the tibia, fibula, talus, and calcaneus. The tibia (or shin bone) is a long bone that goes from just below the knee to the inside of the ankle, and forms the malleolus (or bump) on the inner part of the ankle. The fibula is another long bone that is smaller and runs along the outside of your lower leg and forms another malleolus on the outer part of the ankle. The talus is a smaller, dome shaped bone that sits in between the malleolus from the tibia and the fibula. The calcaneus is the heel bone beneath the talus.

When the ankle plantar flexes (points) the talus rolls forward and the back of the tibia moves closer to the calcaneus. When the ankle dorsiflexes (flexes), the talus rolls back.

Anterior impingement can occur when the ankles dorsiflexes (flexes) and soft tissues or bone gets pinched between the talus and the front of the tibia.

Posterior impingement can occur when the ankle plantar flexes (points) and soft tissues or bone gets pinched between the tibia and the calcaneus.¹

Symptoms of Ankle Impingement

Since anterior impingement affects the front of the ankle, and posterior impingement affects the back of the ankle, different activities can be painful depending on where the impingement is happening. Both anterior and posterior ankle impingement can:²

• Happen with long bouts of exercise
• Be relieved with rest
• Limit ankle movement
• Cause swelling at the ankle

Anterior Ankle Impingement

With anterior ankle impingement, pain typically occurs at the front of the ankle. Symptoms might include:²

• Ankle Instability (ankles that easily sprain or roll)
• Pain with squatting
• Pain with climbing hills, or stairs
• Pain with sprinting
• Swelling

Posterior Ankle Impingement

Posterior ankle impingement can cause pain in the back of your ankle. Symptoms might include:³

• Pain with kicking a ball (such as a soccer ball, or football)
• Pain with running downhill
• Pain with pointing the toe
• Swelling

What are the Most Common Causes of Ankle Impingement?

Both anterior and posterior ankle impingement are caused by repetitive ankle injuries, such as sprains and fractures. Performing activities that cause you to spend a lot of time with the ankle in plantar flexion (pointed) can predispose you to posterior ankle impingement. Whereas, performing activities with the ankle in a dorsiflexed (flexed) position can predispose you to anterior ankle impingement.⁴

What bony surface or soft tissue is being pinched will differ depending on whether you are suffering from either anterior or posterior impingement.

Common Causes of Anterior Ankle Impingement

Structures on the front of the ankle that are typically involved in anterior ankle impingement can include:²

• Bone spurs
• Extra bone growth, or exostosis
• Ligaments (the tissues that hold your bones together)

Common Causes of Posterior Ankle Impingement

Structures at the back of the ankle that are typically involved in posterior ankle impingement can include:³

• Extra bone growth
• Fracture
• Tenosynovitis or swelling of the soft tissue covering of one of the tendons in your foot
• Issues with the cartilage (connective tissue on the surface of the ankle joint)

Diagnosing Ankle Impingement

A healthcare provider, such as a physical therapist, will examine your ankle to determine how it moves. This will help them understand which movements are painful for you. The provider may also perform some tests in the clinic to rule out other foot and ankle conditions.

If needed, diagnosis of ankle impingement can be made with either an X-ray or an MRI of the ankle.¹

What to Expect from Physical Therapy

A CityPT physical therapist can help you to determine if you have ankle impingement and provide an effective treatment plan to manage symptoms. They can also guide you to seek help from another healthcare provider if conservative treatment does not help.

How CityPT can help

When working with a CityPT physical therapist, you can expect the following.

• A subjective evaluation and comprehensive interview
• An in-depth discussion of your goals, and activities that you would like to return to
• A physical examination done over video telehealth, or in person
• Assessment of your ankle range of motion, strength, and movement patterns
• A treatment plan to reach your goals. Possible treatments include:
  • Manual therapy to promote optimal ankle mechanics/mobility and reduce pain
  • Therapeutic exercise to address weakness and coordination
  • Guidance on appropriate footwear
  • Advice on how to safely return to activity

What If Conservative Treatment Doesn't Work?

If conservative treatment does not work, a physical therapist can direct you to a healthcare provider who can perform the following:

• Order imaging such as an X-ray, or MRI
• Prescribe anti-inflammatory medication
• An injection
• Surgery

How Can I Prevent Ankle Impingement?

If you think that you may be predisposed to ankle impingement (particularly athletes), there are things that you can do to make sure that you stay pain-free, and injury-free. These actions can include:

• Modifying or limiting painful activities (as appropriate)
• Wearing adequate footwear when performing activities which may put you at risk for ankle injuries
• Maintaining good movement and mobility at your ankle
• Maintaining adequate ankle and leg strength with consistent exercise
• Maintaining good balance with daily activities and exercise
• Working with a coach, trainer, or CityPT clinician to ensure that you are using good movement patterns

Is It Time to Seek Treatment?

If you think that you have ankle impingement, or are at risk for developing ankle impingement, CityPT is here to help. A CityPT physical therapist can help to determine if your ankle pain is due to ankle impingement, or another cause. They can also work with you to develop a plan that fits your specific needs and allows you to stay active and injury-free.

Book an appointment with a ankle specialist today.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.

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