Ankle joint impingement is a condition where soft tissues or bony structures around the ankle become pinched, leading to pain, restricted movement, and swelling. It typically occurs when repetitive stress or injury causes abnormal contact between bones or soft tissues during ankle motion, particularly at the extremes of movement such as deep dorsiflexion (when the foot bends upward) or plantarflexion (when the foot points downward). This condition is commonly seen in athletes who frequently load the ankle joint, such as footballers, dancers, and runners, but can also affect anyone with a history of ankle trauma.
There are two main types of ankle impingement: anterior impingement (at the front of the ankle) and posterior impingement (at the back of the ankle).
Anterior ankle impingement often occurs following recurrent ankle sprains or chronic ankle instability. These injuries may lead to thickening or scarring of the soft tissue at the front of the joint, or the development of bone spurs (osteophytes). This can cause pain when the ankle bends upwards, particularly during activities like walking uphill, squatting, or running.
Posterior ankle impingement is typically caused by repeated forceful plantarflexion, such as in ballet dancers or footballers striking the ball. It may involve soft tissue entrapment or bony abnormalities like an os trigonum—an accessory bone at the back of the ankle. Symptoms usually include pain when pointing the toes or pushing off during running or jumping.
Common causes of ankle impingement include:
Recurrent ankle sprains
Previous ankle fractures or trauma
Chronic overuse in sports or activities involving extreme ankle movement
Structural abnormalities such as bone spurs or accessory bones
Typical symptoms include:
Persistent ankle pain during certain movements
Stiffness or reduced range of motion
Swelling around the ankle joint
A catching, clicking, or locking sensation
Tenderness at the front or back of the ankle
If left untreated, ankle impingement can limit function and lead to chronic pain. Diagnosis is typically made through a combination of clinical examination and imaging, such as X-ray, MRI, or diagnostic ultrasound, to identify soft tissue or bony causes.
Treatment for ankle joint impingement typically begins with conservative measures such as rest, physiotherapy, activity modification, and anti-inflammatory treatments.
These approaches aim to reduce inflammation, improve joint mobility, and strengthen the surrounding muscles to support the ankle. Ankle joint injections may also be considered to help with pain and inflammation and help facilitate rehab engagement.
However, if symptoms persist despite a structured rehabilitation programme, minimally invasive surgery may be considered.
Arthroscopic (keyhole) surgery is a highly effective and straightforward procedure that allows surgeons to precisely remove the impinging bone spurs or scar tissue through small incisions, with minimal disruption to surrounding tissues. This technique results in faster recovery times, less post-operative pain, and excellent long-term outcomes, particularly for active individuals looking to return to sport or high-level activity.
Most patients can expect a significant improvement in pain and function, and many return to their normal activities within a few weeks to months, depending on the extent of the procedure. Surgery is only considered when conservative treatment has failed, ensuring it is both necessary and likely to lead to a meaningful improvement in quality of life.
