Physical Therapy Guide to Ankle Impingement
Ankle impingement occurs when soft or bony tissues become compressed within the ankle joint at the extreme end of a motion. It often affects people who experience forces through the ankle at extreme positions, such as dancers, gymnasts, football players, or athletes who do kicking motions. Also, people who do repeated tasks that involve squatting or stair-climbing are prone to this condition. Physical therapists help people with ankle impingement reduce pain, heal, strengthen the affected area, and improve overall balance.
What Is Ankle Impingement?
There are two types of ankle impingement:
- Anterior (front) ankle impingement.
- Posterior (back) ankle impingement.
Anterior ankle impingement. This injury causes pain on the front side of your ankle. This type of ankle impingement can result from:
- Inflammation and swelling. These conditions can occur due to repeated stress at end-range positions of the ankle (when the foot is fully flexed upward with toes pointed toward the shin or extended downward with toes pointed toward the sole of the foot), such as when jumping, squatting, or going down stairs. This can lead to inflammation and swelling and the development of bone spurs (a bony overgrowth) in the ankle joint space.
- Ankle instability. This condition is a looseness of the ankle joint that develops after repeated ankle sprains. These sprains cause damage to ankle ligaments. The damage can result in compressed tissue and scarring that takes up more joint space. This causes pain during activities that require stretching your toes up toward your shin (ankle dorsiflexion). Examples of these activities include squatting, jumping, and climbing stairs.
Posterior ankle impingement. This injury causes pain on the back of your ankle, especially during activities that involve pointing your toes. It can result from:
- Compression of soft or bony tissue between the shin bone (tibia) and the heel bone (calcaneus). There are numerous soft tissue structures that could cause posterior impingement. Some people have a small extra bone in the back of their ankle called the Os Trigonum. This little bone can lead to impingement in the back of the ankle, and pain. It causes compression between the shin bone and the heel bone when the foot is pointed.
- Excess force on the ankle. Large amounts of force on the ankle sometimes can cause small pieces to break off of the ankle bone. This leads to compression when moving the foot or toes downward toward the sole of the foot (plantar flexion). The compression causes tissue inflammation and swelling that leads to pain.
Signs and Symptoms
With anterior ankle impingement, you may experience:
- Pain on the front and/or outside of the ankle joint.
- A feeling that the ankle is unstable.
- 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 in end-range positioning.
- Pain at the end range of stretching your toes toward the ground in front of the ankle.
With 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.
- Clicking, popping, or catching of the ankle when attempting to point your toes.
- Increased pain when standing up, or pushing off during walking.
How Can a Physical Therapist Help?
Your physical therapist will work with you to achieve your functional goals. They will help you return to your prior activities without pain. Your treatment may include:
Pain management. Your physical therapist may use ice, massage, or electrical stimulation to help lessen pain and inflammation. They may recommend that you reduce your activity level for a while to allow the inflammation in your ankle to decrease.
Range-of-motion exercises. Your physical therapist may gently move your ankle through its available range of motion. They also may teach you the proper motions to move through to increase mobility and decrease stiffness. If needed, your physical therapist may perform joint mobilizations to skillfully move your ankle joint in a specific direction to improve its motion.
Muscle-strengthening exercises. It is important to strengthen the muscles of 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. This decreases the risk of compression of soft or bony tissues.
Balance exercises. Your physical therapist may teach 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 balance will lead to a more stable ankle, because your body can more easily respond to challenges.
Functional training. Once your physical therapist has helped decrease your ankle pain and inflammation, you will move on to more activity-specific tasks. Your physical therapist will help ensure that your ankle can withstand challenges during work, sport, or performance activities.
** from choosept.com
