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Ankle Impingement Physiotherapy



Ankle impingement happens when either soft or bony tissues are compressed (pinched) within the ankle joint at the extreme end of a motion, such as pointing the foot sharply downward.

This painful injury usually affects people who experience forces through their ankle at these "end-range" positions, such as

  • dancers
  • gymnasts
  • kick boxers
  • soccer players
  • cyclists
  • ie people performing kicking activities

Additionally, people who perform repetitive tasks that involve squatting or stair-climbing are also more at risk to developing ankle impingement too.

What our senior physiotherapists do to help people with ankle impingement is to

What is Ankle Impingement?

There are 2 types of ankle impingement:

  • Anterior ankle impingement
  • Posterior ankle impingement

Anterior (front) ankle impingement

Involves pain on the front side of your ankle. Inflammation and swelling occur due to repetitive stresses at end-range positions of the ankle, such as when one jumps, squats, or descends stairs. These activities, over time, may eventually lead to development of bone spurs (a bony overgrowth) in the ankle joint space.

Another cause of anterior ankle impingement is ankle instability. Ankle instability is a looseness of/within the ankle joint that develops after repeated ankle sprains, causing damage to ligaments in the ankle.

This  kind of ankle damage can cause the ligaments to become scarred and take up more joint space. What happens then is that tissue in the ankle joint space starts to get compressed, causing pain during activities that require ankle dorsiflexion (stretching your toes up toward your shin).

Examples of these activities include

  • squatting
  • jumping
  • stair-climbing

Posterior (back) ankle impingement

Involves pain on the back side of your ankle, especially during activities that involve pointing your toes. The pain is caused by compression of soft or bony tissue between the shin bone (tibia) and the heel bone (calcaneus).

What happens in some people is that they have a small extra bone in the back of their ankle called the Os Trigonum. This little bone can lead to posterior impingement because of compression between the shin bone and the heel bone, when the foot is pointed.

Also, if there is repeated large amounts of force on the ankle, that may cause small pieces to break off the ankle bone, which can also become compressed when the ankle moves into "end-range plantar flexion" (moving the foot or toes downward toward the sole of the foot).

Compression of tissue causes inflammation and swelling that leads to pain.

Signs and Symptoms of ankle impingement

Anterior ankle impingement, you may experience:

  • Pain on the front and/or outside of the ankle joint
  • A feeling of ankle instability
  • Decreased ankle range of motion when stretching your toes up toward your shin
  • Pain at the end-range of stretching your toes toward your shin
  • Tenderness at the front of the ankle when touched

Posterior ankle impingement, you may experience:

  • Pain on the back of your ankle, especially during activities that involve pointing your toes
  • Decreased range of motion when pointing your toes
  • Tenderness on the back of the ankle when touched

How Is ankle impingement Diagnosed?

Your examination will start with your personal health history and current symptoms.

Our senior physiotherapist will ask you

  • when your ankle pain symptoms began
  • where the location of your ankle pain is in/on/around your ankle
  • what types of activities cause your ankle to hurt or to increase its pain

They will also perform a physical examination to evaluate your ankle strength, range of motion, sensation, and structural stability as well as your balance; as well as special tests, such as gently moving your ankle to see if it causes symptoms.

To diagnose posterior ankle impingement in dancers, the exam may be specialized to that activity. For example, our senior physiotherapist may ask a ballet dancer to demonstrate the “en pointe” position, which involves standing on the tips of the toes.

To provide a definitive diagnosis, we may collaborate with an orthopedic doctor.

The most accurate method to diagnose ankle impingement is by X-ray or magnetic resonance imaging (MRI), which can be ordered by them.

How our senior physiotherapist can Help you

Once you have been diagnosed with ankle impingement, our senior physiotherapist will work with you to achieve your functional goals, and help you return to activities you previously performed without pain.

Your treatment may include:

Pain Management. We may use cold therapy or electrical stimulation, if you have inflammation causing pain. We may ask you to reduce your exercise and activity levels for a while, so the inflammation in your ankle can decrease. We may also use ultrasound therapy and radio-frequency Indiba physiotherapy to accelerate soft tissue healing in your ankle.

Range-of-Motion Exercises. We may gently move your ankle through its available range of motion, or teach you the proper motions to move through in order to increase its mobility and decrease stiffness. If necessary, wet may perform joint mobilizations and manual therapy by skillfully moving the joint in a particular direction to improve its motion.

Muscle-Strengthening Exercises. It is important to strengthen the muscles acting on the foot, ankle, and lower leg to promote proper joint mechanics. When the muscles are strong and working properly, the joint space in the ankle is maintained, which decreases the risk of compression of soft or bony tissues.

Balance Exercises. We may give you balance exercises to challenge the way your body reacts to outside forces. These exercises make you more aware of where your body is in space. Improving your balance will lead to a more stable ankle, because your body can more easily respond to challenges.



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All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB).

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At the first session, our specialist physiotherapists will carry out a thorough assessment, helping them to select the most appropriate treatment to help you recover as well as provide treatment in the same session.

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