Footballer’s ankle, also known as anterior ankle impingement, occurs because bony spurs form at the front of the ankle joint. The spurs can form at the bottom end of the joint on the talus or the top end of the joint on the tibia. When the joint bends forwards or dorsiflexes, the bony spurs pinch, causing pain at the front of the ankle. How do we get a footballer’s ankle, and what can we do about it?
Cause of Footballer’s Ankle
We believe that bony spurs form most commonly in athletes involved in sports that require changes of direction or kicking. Repetitive microtrauma or repetitive ankle sprains can lead to the formation of bony spurs. Thus, this condition is called ‘athlete’s ankle’ or footballer’s ankle.’
Sometimes, ankle impingement can occur due to soft tissue swelling at the front of the ankle. Tendons, ligaments and the joint capsule can become swollen due to repetitive kicking or a history of ankle sprains.
Common sports that involve anterior ankle impingement include football, rugby, gymnastics, volleyball, and ballet.
Footballer’s ankle symptoms
People with a footballer’s ankle typically experience pain when pushing their foot upwards, called dorsiflexion. People often experience pain at the front of the ankle, which may be tender to the touch. Additionally, the front of the ankle may appear swollen.
When your doctor examines your ankle, they will notice a restriction in movement, specifically in dorsiflexion (bending your knee over your toes). Often, it is helpful to compare the amount of bend to the other side and other players at your same level.
Generally, diagnosis is made by a weight-bearing X-ray with the ankle bent forward. Often, bony spurs can easily be seen on a side X-ray. Other investigations, such as MRI and Ultrasound, can confirm the bony spur and also clarify the extent of soft tissue swelling causing impingement. An MRI scan can exclude other causes of pain at the front of the ankle, such as tendonitis or ankle arthritis.
Footballer’s Ankle Treatment
Treatment of anterior ankle impingement typically starts with simple treatment, including the following:
- rest from sport
- regular ice
- anti-inflamamtory medication such as ibuprofen
- heel wedges in both shoes
- soft tissue and joint mobilisation of the ankle and subtalar joint
- strengthening of the calf and the small intrinsic muscles of the foot
- An ankle brace can provide extra support and reduce pain.
In cases that fail simple treatment, we think about a cortisone injection. Generally, we do a cortisone injection with ultrasound to improve accuracy and effectiveness. Also, injecting cortisone into the soft tissue inflammation will reduce the leak to the subcutaneous tissue and subsequent depigmentation. Primarily, cortisone injections reduce soft tissue impingement but do not affect bony spurs.
Surgery for a footballer’s ankle is only reserved for cases that fail all conservative measures. Generally, we remove bony spurs by keyhole surgery. Sometimes, the bone spurs are so large that an open excision must be performed. Regardless of the type of surgery, only 75% of people return to their previous sport, indicating that surgery should be reserved as a last resort.
Other Frequently Asked Questions about Footballers’ Ankle:
What causes pain in a footballer’s ankle?
We are unsure, but we believe that inflamed tissue around the bony spurs at the front of the ankle may cause ankle pain. When we bend the ankle, this soft tissue inflammation becomes squashed, leading to more pain.
Do bony spurs regrow after surgical removal?
Yes. Two-thirds of surgical cases have evidence of bony regrowth after five years. But most of these cases are symptom-free.
Final word from Sportdoctorlondon about anterior ankle joint impingement
Impingement of the front of the ankle is a common condition among athletes and runners. Generally, people feel pain, swelling and restriction at the front of the ankle. Treatment should follow a step-up treatment approach, with surgery last.
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