Antero-Lateral Ankle Impingement

Injuries > Ankle > Antero-Lateral Ankle Impingement

(Also known as Antero-Lateral Impingement Syndrome)

 

What is antero-lateral ankle impingement?

 
The talus is a small bone of the ankle responsible for transferring weight bearing forces from the shin to the foot (figure 1).During the movement of ankle dorsiflexion (figure 2) and ankle eversion (figure 3), the bottom of the shin bone approaches the talus. This places compressive forces on the structures at the outer / front aspect of the ankle joint. If these forces are excessive or beyond what the ankle can withstand, damage and inflammation of these structures may occur. This condition is known as antero-lateral ankle impingement. Occasionally, bony spurs can also form at the outer / front aspect of the ankle joint which may contribute to the problem
 

Causes of antero-lateral ankle impingement

 
Antero-lateral ankle impingement may occur following repeated ankle sprains or following a major sprain. It may also occur following activities requiring repeated forced dorsiflexion (figure 2) 
 

Signs and symptoms of antero-lateral ankle impingement

 
Patients with this condition typically experience pain at the outer / front aspect of the ankle that increases with excessive dorsiflexion or weight bearing activity such as running.
 

Treatment for antero-lateral ankle impingement

It is recommended that patients with antero-lateral ankle impingement undergo a physiotherapy program as the first line of treatment. One of the key components of this program is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to activity is indicated provided there is no increase in symptoms.
 

Ignoring symptoms or adopting a ‘no pain no gain’ attitude is likely to aggravate the condition and may lead to the problem becoming chronic. Immediate appropriate treatment is essential to ensure a speedy recovery.

Patients with this condition should follow the R.I.C.E. regime in the initial phase of injury. The R.I.C.E regime is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). The R.I.C.E. regime involves rest from aggravating activities (crutches may be required), regular icing, the use of a compression bandage and keeping the leg elevated. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.

A graduated and pain-free flexibility, strength and return to activity program under direction from a physiotherapist is vital to ensure an optimal outcome.

Alternative exercises placing minimal weight bearing forces through the ankle should be performed to maintain fitness such as swimming, cycling, and water running.

 

Contributing factors to the development of antero-lateral ankle impingement

 

There are several factors which can predispose patients to developing antero-lateral ankle impingement. These need to be assessed and corrected with direction from a physiotherapist. Some of the factors which may contribute to the development of this condition include:

  • joint stiffness or swelling
  • muscle tightness
  • poor foot biomechanics
  • inappropriate training (including technique, footwear or training surfaces)
  • inadequate rehabilitation following previous injury
  • a history of ankle trauma
 

Physiotherapy for antero-lateral ankle impingement

 

Physiotherapy treatment is vital to hasten the healing process and ensure an optimal outcome in all patients with this condition. Treatment may comprise:

  • soft tissue massage
  • joint mobilisation
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • stretches
  • ankle taping
  • ankle bracing
  • the use of crutches
  • the use of heel wedges
  • ice or heat treatment
  • exercises to improve flexibility, strength and balance
  • education
  • activity modification advice
  • biomechanical correction
  • a gradual return to activity program

Other intervention for antero-lateral ankle impingement

 
Despite appropriate physiotherapy management, some patients with this condition do not improve. When this occurs the treating physiotherapist can advise on the best course of management. This may involve investigations such as an X-ray, MRI or CT scan, pharmaceutical intervention, corticosteroid injection or review with a specialist who will advise on any procedures that may be indicated to improve the condition. Occasionally, surgical intervention may be indicated to remove the bony spur or damaged tissue. Review with a podiatrist for appropriate footwear advice and possible orthotics may also be indicated.
 

Exercises for antero-lateral ankle impingement

The following exercises are commonly prescribed to patients with antero-lateral ankle impingement. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 – 3 times daily and only provided they do not cause or increase symptoms.

Foot and Ankle Up and Down

Move your foot and ankle up and down as far as possible and comfortable without pain (figure 3). Repeat 10 – 20 times provided there is no increase in symptoms.

Ankle eversion

Figure 3 – Ankle eversion

Exercises for Ankle Impingement - Foot & Ankle Up & Down

Figure 3 – Foot and Ankle Up and Down

Foot and Ankle In and Out

Move your foot and ankle in and out as far as possible and comfortable without pain (Figure 4). Repeat 10 – 20 times provided there is no increase in symptoms.

Exercises for Ankle Impingement - Foot and Ankle In and Out

Figure 4 – Foot and Ankle In and Out

Foot and Ankle Circles

Move your foot and ankle in a circle as large as possible and comfortable without pain (figure 5). Repeat 10 – 20 times provided there is no increase in symptoms. Perform the exercise clockwise and counter-clockwise.

Exercises for Ankle Impingement - Ankle Circles

Figure 5 – Foot and Ankle Circles

Kneeling Stretch

Begin in four point kneeling (i.e. on your hands and knees) on a flat surface. Keep your knees and ankles together, toes pointed. Gently take your weight back onto your ankles until you feel a stretch at the front of your ankles or shins (figure 6). Hold for 15 seconds 4 times at a mild to moderate stretch pain-free. This exercise can be progressed by placing a rolled towel under your feet as demonstrated.

Exercises for Ankle Impingement -Kneeling Stretch with Towel

Figure 6 – Kneeling Stretch

Find a Physio for Antero-lateral Ankle Impingement

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Physiotherapy products for Antero-lateral Ankle Impingement

Some of the most commonly recommended products by physiotherapist for patients with this condition include:

  1. Ankle Braces
  2. Crutches
  3. Ice Packs or Heat Packs
  4. Heel Wedges
  5. Wobbleboards or Duradiscs
  6. Sports Tape

To purchase physiotherapy products for Antero-Lateral Ankle Impingement click on one of the above links or visit the PhysioAdvisor Shop.

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