Anterior Ankle Impingement

(Soft Tissue and Bony)

Anterior Ankle Impingement Overview

Anterior ankle impingement is a condition where structures at the front of the ankle joint become compressed or irritated, particularly during upward ankle movement (dorsiflexion). It can involve soft tissue (such as thickened joint lining or scar tissue) and/or bony spurs that form along the front edge of the ankle bones.

This condition often occurs in people who perform repetitive ankle movements — such as runners, dancers, footballers, and other athletes — and is also seen following ankle sprains, instability, or repeated trauma. It can cause pain, stiffness, and reduced range of motion, especially during activities like squatting, walking uphill, or pushing off during sport.

Anterior Ankle Impingement Symptoms and Diagnosis

Common symptoms include:

• Sharp or aching pain at the front of the ankle

• Pain or restriction when bending the ankle upward (e.g. stairs, lunging, or squatting)

• Swelling or thickening at the front of the joint

• A sensation of blocking, catching, or pinching in the joint

• Stiffness, especially in the morning or after exercise

• Symptoms often worsen with activity and improve with rest

Diagnosis is made through clinical examination and confirmed with imaging. X-rays can show bony spurs or osteophytes, while MRI scans help identify soft tissue thickening, synovitis, or scar tissue. In some cases, ultrasound or CT may be used to assess fine details of the joint or surrounding structures.

Anterior Ankle Impingement Causes

Anterior impingement typically results from repetitive stress or previous injury to the ankle joint. Common causes include:

• Repeated ankle sprains, particularly inversion injuries

• Chronic ankle instability

• Repetitive dorsiflexion in sports or dance

• Formation of bony spurs (osteophytes) along the tibia or talus

• Build-up of scar tissue, inflamed synovium, or joint capsule thickening

• Post-traumatic changes after ankle fractures or cartilage injury

Both bony and soft tissue changes can coexist and lead to progressive narrowing of the joint space at the front of the ankle.

Anterior Ankle Impingement Treatment and Prevention

Non-surgical management is often the first line of treatment and may include:

• Activity modification to avoid aggravating movements

• Anti-inflammatory medication (NSAIDs)

• Physiotherapy, including ankle mobilisations and strengthening exercises

• Manual therapy to improve joint mechanics

• Supportive footwear or orthotics to offload the ankle

• Steroid injections under ultrasound guidance to reduce inflammation and improve symptoms

A combination of rest, rehabilitation, and gradual return to activity often helps relieve symptoms in mild to moderate cases.

Anterior Ankle Impingement Surgery

If symptoms persist despite conservative management, surgery may be recommended to remove the impinging structures.

Surgical options include:

• Arthroscopic debridement (keyhole surgery) to remove soft tissue impingement, such as thickened synovium or scar tissue

• Arthroscopic or open cheilectomy to remove bony spurs or osteophytes from the front of the tibia or talus

• In some cases, removal of loose bodies, smoothing of the joint surface, or treatment of associated cartilage damage may be performed

The goal of surgery is to restore full range of motion, relieve pain, and allow return to physical activity.

Mr Hester will discuss the specific surgical plan with you, including whether a keyhole or open approach is appropriate, based on the nature of your impingement and imaging findings.

Anterior Ankle Impingement Surgery Recovery

After surgery, the ankle is initially protected to allow the joint to settle and heal:

• You will usually be placed in a post-operative boot and may be partially weight-bearing with crutches for the first 1–2 weeks.

• A wound check is done at 2 weeks, and physiotherapy begins shortly after.

• Most patients transition to full weight-bearing by 2–4 weeks, depending on comfort and progress.

• Physiotherapy focuses on restoring ankle range of motion, strength, and proprioception

• Return to sport or high-impact activity is guided by your recovery but typically starts around 12 weeks after surgery

0–2 weeks

Protected in boot. Partial weight-bearing. Elevation and rest.

2 weeks

Wound review. Transition to supportive shoes. Begin physiotherapy.

2–6 weeks

Increased walking and functional movement. Swelling may persist.

6–12 weeks

Return to normal activities. Most patients resume low-impact sport.

12+ weeks

Gradual return to high-impact activity or full sport if pain-free and strength has returned.