Symptom & Cause
The main symptom of bony impingement of the ankle is pain at the front of the ankle joint, when the ankle bend upwards (dorsiflexion) causing the two bones at the front of the ankle (tibia and talus) to jam (impinge) into each other. If the impingement is from a bone spur (osteophytes), as it often is, then a noticeable loss of upward motion of the ankle joint may be present.
Any activity that causes the ankle joint to jam together, meaning sudden forced upward movement of the ankle joint, will likely increase discomfort. Ankle impingement is associated with recurrent ankle sprains; it is seen commonly in soccer players or individuals who repetitively load the ankle joint.
The classic physical exam findings are tenderness along the front of the ankle joint that is worsened when moving the foot upward (dorsiflexion), and limited upward movement of the foot (limited dorsiflexion). X-rays can also help in diagnosis.
In some instances, symptoms can be improved with non-operative treatment. Non-operative treatment is designed to either: limit the number of times (and force) that the ankle joint jams; or decrease the pain response from the ankle joint. Some potentially effective non-operative treatments are:
- Use of a Slightly Elevated Heel (or adding a heel lift inside the shoe): This means the foot does not need to come up as far in the course of normal walking and running. Therefore, less impingement occurs and patients will tend to be less symptomatic.
- Taping the Ankle or Use an Ankle Brace: This will limit ankle motion in general and in turn will tend to decrease symptoms.
- Activity Modification: Avoiding or limiting activities that cause ankle impingement will tend to cause the symptoms to improve.
In other instances of bony ankle impingement, surgical treatment can help symptoms. Surgical treatment of ankle impingement involves removal of impinging bone spurs either arthroscopically (keyhole surgery) or by opening up the ankle joint with an incision (open surgery).
If the bone spurs are large, it is often more efficient and effective to make a larger incision and open up the ankle joint to remove the bone spurs rather than attempt to do this arthroscopically. Removal of all bone spurs is not required, rather only those which are noted to be causing impingement at the time of surgical inspection.
Surgery to remove the bone spurs can lead to an improvement in a patient’s symptoms – improvement in pain symptoms and increased range of ankle dorsiflexion (allows the ankle joint to move more). However, as the bone spurs is usually formed due to some other stimulus, it is not uncommon for the bone spurs to recur after it has been removed surgically.