In ankle impingement there is a limitation in the joint mobility of the ankle due to pain from a soft tissue or bony pathology. A common finding to precipitate this pain syndrome is an irritation of the synovial membrane or the joint capsule, typically after an ankle sprain or a repetitive series of such injuries. Chronic pain in the ankle and impingement can result from the ankle being sprained and this can give a persistent pain problem with limitations on involvement in sports. Numbers are unclear but some level of impingement could occur in about ten percent of people who undergo ankle sprains.

Impingement is often secondary to an acute ankle sprain where the person stands on something uneven or puts their foot into a hole in the ground, forcing the foot over into a downwards and inwards movement with the weight of the body. Anterior impingement occurs at the front of the ankle and posterior impingement behind, with another lesion type involving the connecting joint between the fibula and the tibia just above the ankle joint proper. An anterior blocking feeling is often reported by patients with this impingement as they try and get the foot up in the ankle. Moving the ankle into dorsiflexion with weight on it can bring on the pain.

If the syndesmosis (the connecting joint between the fibula and tibia) has been injured and is causing symptoms, then palpating the local area may be extremely tender and pain elicited on compressing the malleoli together. It is more difficult to diagnose posterior impingement as the symptoms are often not so obvious although a forced downward movement of the foot may be painful. Repeated lunging movements such as in ballet and fencing and kicking a ball in football can bring on anterior impingement as the front of the joint suffers repeated microscopic damage which results in bony spur formation.

Ankle impingement is difficult to investigate with the usual imaging methods as little may be apparent. Normal x-rays, bone scanning and computed tomography (CT) scanning often show little abnormal, although people with a diagnosis of anterior impingement may show spurs of bone on the front surfaces of the ankle bone (talus) and the tibia. MRI scanning (magnetic resonance imaging) is more helpful to show bony or soft tissue problems.

Conservative management is the mainstay of treatment for this condition and patients can reduce their symptoms if they modify the activity levels they are performing or alter their techniques and methods. Non-steroidal anti-inflammatory drugs can be prescribed to counter the pain and inflammatory changes. Referral to physiotherapy is common to attempt joint mobilisation methods on the foot and ankle, apply ultrasound, give deep friction massage and work on muscle power and joint motion. An ankle brace can be fitted to support the joint laterally or to restrict the range of motion and physiotherapists can also assess and fit orthotics in the shoes.

Conservative treatment methods may not settle impingement pain and then consideration turns towards surgical intervention. Modern operation is usually performed arthroscopically, any loose tissue cut away, and bony spurs or soft tissue abnormalities removed. Patients can rapidly mobilise after surgery and almost normal walking can start a few hours after operation provided minor work has been performed. Patients may need to wait 4 to 6 weeks before fully resuming their normal routines, in some cases guided by physiotherapists. Results from trials of surgery for this condition have shown that eighty percent have good to excellent outcomes.

In cases of more extensive surgery the patient may have to walk with crutches to limit the weight taken by the ankle and wear an ankle brace to limit movement, moving up to bearing full weight over a couple of weeks. At this point the physiotherapist may remove the brace and initiate range of movement exercises to restore normal movement to the foot and ankle. Ultrasound and ice can also be used to control inflammation and pain. With the ankle improving the physiotherapist will move the patient on to exercises without weight such as static bicycling in the gym, and then to exercises on their feet to work on strength, balance, coordination and joint position sense.