Anterior ankle impingement is also called “footballer's ankle” and occurs when tissue or bone gets stuck in the joint. This results in crunching sensations and locking at the end of ankle movements. Swelling and pain at the front and inner sides of the fibula are common.

Causes & symptoms

Anterior ankle impingement is usually caused by an ankle sprain. In these cases, the ligament does not heal properly. The scar may be too large and bulge into the joint or it may be lined with part of the joint capsule which remains inflamed and painful. In other cases, it is caused by a fragment of bone from the ligament attachment which persists in the ankle.

Other events can cause anterior ankle impingement such as repeated microtrauma, for example, the foot striking a ball or the ground (e.g. when running). A bony projection (bone spur) forms at the front of the ankle and hinders flexion and extension movements.

This condition is diagnosed using an MRI scan or CT arthrogram.

Anterior ankle impingement: treatments

A steroid injection can be administered during your consultation as an initial treatment. This treatment is effective in one in two patients.

If this treatment fails, an ankle arthroscopy should be considered. This procedure consists of inserting a tiny camera and surgical tools into the ankle joint. It is performed under general or regional anaesthetic through two 1 cm incisions. The camera enables the damage to be assessed and the type of impingement to be confirmed. The surgeon will then remove the source of the impingement, whether it be a bone spur, an excessively large ligament scar, etc. Finally, the joint is washed out and the incisions are closed.

Follow-up after surgery

You can be discharged the same day and weight bearing with crutches is allowed immediately after the procedure. Immobilization of the ankle is not necessary, however, rehabilitation should be started five to 10 days after the procedure. Your dressings will be tended to by a nurse and instructions on elevating the leg and how to ice the ankle will be provided. Pain medication will also be prescribed.

The ankle will be swollen for six to eight weeks and you will need to take three to five weeks off work depending on your job. A follow-up consultation will take place to check how your recovery is going. As mentioned above, the swelling may last a long time, but rest assured that you will feel an improvement long before it goes down. The vast majority of patients see an improvement as a result of this procedure.