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 on the tibia. When the joint bends forwards (dorsiflexes), the bony spurs pinch, causing pain at the front of the ankle. So how do you get a footballer’s ankle, and what can you do about it?
What causes footballer’s ankle?
Bony spurs form most commonly in athletes doing sports that involve changes of direction or kicking. Repetitive microtrauma, or repeated ankle sprains, leads to the spurs forming — which is why this condition is called “athlete’s ankle” or “footballer’s ankle”.
Sometimes anterior ankle impingement is caused instead by soft-tissue swelling at the front of the ankle. Tendons, ligaments, and the joint capsule can swell from repetitive kicking or a history of ankle sprains.
Sports commonly associated with anterior ankle impingement include football, rugby, gymnastics, volleyball, and ballet.
Footballer’s ankle symptoms
People with a footballer’s ankle typically have pain when pushing the foot upwards (dorsiflexion). The pain is at the front of the ankle and may be tender to touch, and the front of the ankle can look swollen.
On examination, your doctor finds restricted movement, specifically in dorsiflexion (bending the knee forward over the toes). It helps to compare the range with the other side, and with other players at the same level.
How is footballer’s ankle diagnosed?
Diagnosis is usually made with a weight-bearing X-ray taken with the ankle bent forward, on which the bony spurs are often easily seen on a side view. Other investigations, such as MRI and ultrasound, confirm the bony spur and clarify the extent of any soft-tissue swelling. An MRI can also exclude other causes of front-of-ankle pain, such as tendonitis or ankle arthritis.
Footballer’s ankle treatment
Treatment of ankle bone spurs typically starts with simple measures:
- Rest from sport
- Regular ice
- Anti-inflammatory 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, for extra support and to reduce pain
In cases that do not respond to simple treatment, we consider a cortisone injection, performed under ultrasound guidance to improve accuracy and effectiveness. Ultrasound also reduces cortisone leakage into surrounding tissue and the risk of skin depigmentation. A cortisone injection reduces the soft-tissue impingement, but doesn’t affect the bony spurs themselves.
Surgery is reserved for cases that fail all conservative measures. We usually remove bony spurs via keyhole surgery, though very large spurs may require an open excision. Whichever approach is used, only about 75% of people return to their previous level of sport, which is why surgery is a last resort.
Frequently asked questions about ankle bone spurs.
What causes the pain in a footballer’s ankle?
We believe the inflamed soft tissue around the bony spurs at the front of the ankle is the main source of pain. When the ankle bends forward, this inflamed tissue is squashed between the spurs, causing pain.
What’s the difference between a footballer’s ankle and posterior ankle impingement?
They’re opposite ends of the ankle. A footballer’s ankle is anterior impingement — pain at the front, worse when the foot bends up (dorsiflexion). Posterior ankle impingement causes pain at the back of the ankle, worse when the foot points down (plantarflexion), and is often linked to an os trigonum. They’re different conditions with different causes and treatments.
Can you play football with a footballer’s ankle?
Often yes, with management — heel wedges, an ankle brace, load modification, and calf and foot strengthening. It’s best to settle an acute flare first, then return gradually. Persistent or worsening pain despite these measures is a reason to get assessed.
Do ankle bone spurs need surgery?
Not usually. Most cases settle with simple measures and, if needed, a cortisone injection for the soft-tissue component. Surgery to remove the spurs is a last resort, with about a 75% chance of returning to the previous sport.
Do the ankle bone spurs grow back after surgery?
Yes. About two-thirds of surgical cases show some bony regrowth within five years — but most of these remain symptom-free.
Final word from Sport Doctor London about anterior ankle impingement
Impingement at the front of the ankle is common in athletes and runners, causing pain, swelling, and restriction. Treatment should follow a step-up approach, with surgery reserved as a last resort.
If you have persistent front-of-ankle pain, Dr Masci can assess you in London, including an ultrasound in the clinic. Contact the team here or call +44 (0) 203 488 0350.
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