Ankle Bone or Joint Injury
Anterior Ankle Impingement
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Footballer’s Ankle: Anatomy
Footballer’s Ankle is also known as an anterior ankle impingement characterized by pain and swelling at the front of the ankle joint.
The ankle joint is made up of 3 bones; the medial and lateral malleoli (shin bones), and they sit on top of the Talus bone. The ankle joint forms a synovial hinge joint, allowing it to move back and forth (plantarflexion and dorsiflexion) while being a major weight-bearing structure.
The ankle joint plays an important role in connecting the leg to the foot and works as a shock absorber during impact activities. If the boney articulations of the ankle joint, associated tendons or ligaments become irritated, they can develop into the symptoms of a Footballer’s Ankle.
Throughout this article, we will explain the key symptoms, causes and diagnosis of Footballer’s Ankle and help you understand the best treatment.
Footballer’s Ankle: Symptoms
Footballer’s Ankle causes pain and swelling on the front of the ankle that is normally worse after impact activity and change of direction sports.
If there is a bony spur, patients may find lifting their foot upwards (dorsiflexion) particularly painful as the bone pinches on the surrounding soft tissues.
Footballer’s Ankle is often associated with a history of ankle sprains, so patients may have ankle instability with or without a clicking or catching sensation.
Running uphill can exacerbate symptoms, while kicking a ball is often painful.
Causes of Footballer’s Ankle
A common cause of Footballer’s ankle is an impingement of the soft tissue and a bony growth or spur (osteophyte) that develops on any of the 3 bones that make up the ankle joint.
Other causes of Footballer’s ankle include impingement of soft tissues such as tendons, ligaments, and the joint capsule due to repetitive actions such as lifting the foot upwards (dorsiflexion) or regularly kicking a ball on the front of your foot.
Repetitive ankle sprains can cause instability and trauma to the ankle joint, resulting in cartilage tears (osteochondral lesions) and bony spur development in the ankle, leading to impingement.
Previous injuries to the ankle joint, such as fractures or dislocations, can also increase the risk of developing bony spurs and impingement of soft tissues.
Footballer’s Ankle: Diagnosis
Following a clinical interview and physical examination, it is possible to reach a diagnosis based on your symptoms and a positive anterior ankle impingement test.
The distinction between deep and superficial pain is important,
because deep ankle pain on weight-bearing is typically related to
an osteochondral lesion.
Tenderness while palpating the anteromedial or
anterolateral ankle joint line is the most important characteristic of this condition.
A positive anterior ankle impingement test is confirmed when pain is provoked by applying direct pressure over the antero-
lateral ankle, as the foot is placed in dorsiflexion. It has a sensitivity of 94.8% and a specificity of 88%.
If your clinician requires more detail, they may request an MRI as it provides analysis of the soft tissues around the front of the ankle alongside the bone structure.
Footballer’s Ankle Treatment
Icing the front of your ankle can provide temporary pain relief from Footballer’s ankle. We recommend applying the ice with a barrier such as a clot to prevent skin burns for 10-15 minutes after exercise, which can be repeated 3-4 times daily.
Soft tissue massage of the calf and Anterior Tibialis muscles can relieve pain. We recommend seeing a sports massage therapist who can effectively treat muscular tightness and soreness, or you can carry out self-massage using a foam roller or a massage gun.
Stretches to the surrounding muscles can help to offload the front of the ankle, and we have provided an article with recommended stretching and strengthening exercises for this condition.
An Ankle Brace, such as a lace-up ankle brace, can provide extra stability to the ankle joint and reduce pain levels. Braces are more helpful for patients who experience ankle instability.
A Physical therapist may perform massage, distractions, and mobilizations and provide a structured rehabilitation plan involving graded strengthening and balance exercises. Rigid taping applied by a Physical Therapist can help to offload the front of the joint, while kt tape has minimal to no benefit for Footballer’s Ankle.
If symptoms fail to settle with Physical Therapy, an ultrasound-guided steroid injection may be required to relieve pain. An injection helps to reduce inflammation levels and is used for symptom management to facilitate rehabilitation rather than an isolated solution. This usually takes a couple of weeks to take effect before recommending Physical Therapy.
If conservative management is unsuccessful, surgery may be required for Footballer’s ankle. This often involves a keyhole arthroscopic surgery to remove any bony spurs or scar tissue that’s accumulated in the front of the ankle.
Physiotherapy with James McCormack
This is not medical advice, and we recommend a consultation with a medical professional such as James McCormack to achieve a diagnosis. He offers Online Physiotherapy Appointments weekly.
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How long does Footballer's Ankle Take to heal?
It takes 4-6 weeks for Footballer's ankle to heal under the care of a Physical Therapist. If there is no change in symptoms at that stage, a corticosteroid injection may be necessary.