Ankle impingement is a painful condition that prevents full movement of the ankle. It usually occurs when the ankle is fully bent, either up or down, causing pain at the front (anterior impingement) or the back (posterior impingement) of the ankle joint.

Anterior ankle impingement is more common and often referred to as 'footballers ankle'. In this case, the ligaments get thicker and are pinched between the bottom of the shin bone and the bones of the foot.

Subsequent healing can lead to the formation of too much scar tissue in the region and bony growths known as osteophytes, resulting in ankle impingement.

Posterior ankle impingement, often referred to as 'dancers heel', is less common. It occurs at the back of the ankle and is caused by damaged ligaments, tendons or the joint capsule at the back of your ankle becoming swollen.

Over time the tissues can thicken, and your body may attempt to heal by producing a bony growth/spur which can then cause further pinching of the soft tissues.

Anterior ankle impingement is frequently caused by a bad or a repeated ankle sprain and can cause weakness in the joint for a long time after the original injury.

Posterior ankle impingement is caused by repetitive compression of the bones at the back of your ankle causing the soft tissues to become pinched and swollen, eventually this can lead to a bony growth protruding at the back of the joint. Posterior impingement can also result from poor rehabilitation after an ankle strain or might be as a result of an extra piece of bone being present at birth.

Ankle impingement can also be caused by arthritis.

Anterior ankle impingement symptoms include:

• Anterior ankle pain (pain at the front or the side of the ankle)
• Pain remaining after an ankle sprain has healed
• Ankle weakness

Posterior ankle impingement symptoms include:

• Pain at the back of the ankle
• Tenderness behind the bottom tip of the fibula (calf bone)
• Pain worse at the end of the movement when the foot is pointed down
• Doing tiptoes may be painful

Your GP can usually identify the condition by discussing your symptoms and after a quick examination of your ankle. You may be referred to our Orthopaedic Consultants for further diagnostic ankle impingement tests, such as x-rays or an MRI scan. They’ll also be able to recommend treatment.

Ankle impingement (anterior ankle impingement or posterior ankle impingement) is usually successfully treated with rest or a steroid injection. More severe or recurring cases may sometimes require surgery. The exact type of surgery you have will depend on the cause, location and severity of the ankle impingement.

Surgery involves removing the bone or soft tissue that’s causing the ankle impingement; this can usually be carried out arthroscopically (keyhole technique) or, if the bone spurs are large, by open surgery on the ankle joint.

The operation may be carried out under a general anaesthetic (so you’ll be asleep) or a local anaesthetic (so you’ll stay awake but won’t feel anything). The operation usually takes around an hour and you’ll usually go home on the same day.

Immediately after surgery we’ll help you manage any pain or discomfort with painkillers. We’ll discuss your aftercare and arrange any follow-up appointments with you before you leave hospital.

In the next few days you’ll be able to walk with the aid of crutches but you’ll need plenty of rest with your leg raised. You’ll be offered a programme of physiotherapy to aid your recovery, and we’ll let you know how soon you’ll be able to resume normal day to day activities.