Anterior and posterior ankle impingement
Understanding this condition
Ankle impingement refers to pain triggered by a mechanical catching between bony or tendinous structures during certain movements. Two forms are distinguished based on location.
Anterior ankle impingement occurs during dorsiflexion (pulling the toes up towards you). A bony spur, often secondary to repeated microtraumas or old sprains, catches at the front of the joint. This is a typical condition in footballers, dancers, and those who participate in pivoting sports.
Posterior ankle impingement occurs in the opposite movement, during plantarflexion (pointing the foot down). It is caused by the presence of an accessory bone (the os trigonum) or a bony prominence at the back of the talus, which becomes pinched. This condition mainly affects dancers (on pointe), footballers (kicking), and those participating in forced plantarflexion sports.
Symptoms
For anterior impingement: pain on the front of the ankle, triggered by forced dorsiflexion (squatting, walking uphill, kicking a football). Catching sensation, sometimes locking. The ankle may be swollen at the front.
For posterior impingement: pain at the back of the ankle, below the Achilles tendon, triggered by forced plantarflexion (heel-raised, pointe, kicking). Often confused with Achilles tendinopathy but the exact location of pain differs.
How can it progress?
Without management, the impingement is self-perpetuating: each triggering movement maintains inflammation and may enlarge the bony spur over time. Functional impairment progressively limits sporting activity and certain everyday movements.
The prognosis remains favourable however: these impingements do not degrade the joint as a whole, and their treatment, medical or surgical, gives good results.
Treatment options
First line: relative rest, analgesics, physiotherapy (stretching, proprioceptive work), and sometimes a precisely targeted cortisone injection. Temporary adaptation of sporting activity is often necessary.
In cases of failure or persistent symptoms in athletes, ankle arthroscopy can remove the anterior bony spur or the posterior os trigonum. This is a minimally invasive procedure with rapid recovery. A consultation and imaging (X-rays, sometimes CT scan) confirm the diagnosis and establish the indication.