Anterior Ankle Impingement Syndrome

Athlete's Ankle or Footballer's Ankle Causes Pain

Run off your heels. Yuri_Arcurs/DigitalVision/GettyImages

Anterior ankle impingement syndrome is a condition that occurs when bone spurs form in the front of the ankle joint. The bone spurs can either form on the end of the shin bone (the tibia), on top of the ankle bone (the talus), or on both. When the foot is pushed upwards, the bone spurs pinch, causing pain over the front of the ankle.

Who is at Risk for Anterior Ankle Impingement Syndrome?

Anterior ankle impingement syndrome was often referred to as "athlete's ankle" or "footballer's ankle." Anterior ankle impingement is thought to be the result of repetitive microtrauma (overuse injury) to the ankle, although there are other possible causes of the condition, including ankle sprain.

It is common in athletes and artists whose crafts require repetitive ankle dorsiflexion - raising the foot upward at the ankle. These include soccer players, who also sustain many blows from the ball and other players at the ankle, football players, ballet dancers, runners and gymnasts. Bone spurs and osteophytes are seen on X-ray for almost half of athletes in these sports, yet most have no symptoms.

Symptoms and Diagnosis of Anterior Ankle Impingement

The typical symptom of anterior ankle impingement is pain over the front of the ankle joint, especially when the foot is pushed upwards towards the shin in dorsiflexion. This area is often tender, and occasionally the bone spur can be felt over the front of the ankle. The pain is often relieved when the ankle is allowed to plantar flex. Repeated ankle sprains are another symptom. You may note that your ankle is swollen after activity.

The diagnosis of anterior ankle impingement is usually made with an X-ray, although other tests, such as an MRI, ultrasound or CT scan may be used to confirm the diagnosis and ensure there are not other problems in the ankle joint that could be causing pain.

Treatment of Anterior Ankle Impingement

The usual treatment of anterior ankle impingement syndrome is aimed to decrease inflammation at the site of the impingement. This can be accomplished with rest, oral anti-inflammatory medications, ice applications, heel wedges in shoes, ankle bracing, and possibly a cortisone injection.

Ankle bracing may be especially considered if you have had repeated ankle sprains. Orthotics may be prescribed to correct foot alignment.

If these treatments are not successful, a surgical procedure may be considered to remove the bone spurs. Ankle arthroscopy is often utilized in the treatment of anterior ankle impingement syndrome. The surgery removes the bone spurs (osteophytes) that are causing the impingement.

For large osteophytes, open debridement surgery may be recommended. This surgery is done carefully to ensure there isn't damage to the artery or the deep peroneal nerve in this area of the ankle.

Arthroscopic debridement of bony and soft tissue impingements has had a good success rate. There is a shorter recovery time and return to sports activities compared with open debridement surgery. Most patients had good pain relief but only about a quarter of them could return to their previous level of sports.

After surgery, you will wear a walking boot for two weeks, followed by physical therapy to restore range of motion and build strength and endurance.

You'll be allowed to return to sports after six to eight weeks.


Niek van Dijk C and van Bergen CJ "Advancements in Ankle Arthroscopy" J. Am. Acad. Ortho. Surg., November 2008; 16: 635 - 646.

Tanawat Vaseenon and Annunziato Amendola. "Update on anterior ankle impingement." Curr Rev Musculoskelet Med. 2012 Jun; 5(2): 145–150.

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