What Causes Pain in the Front of the Ankle?
In this article and video I want to talk about pain in the very front of the ankle, in particular a condition called anterior ankle impingement syndrome.
What is Anterior Ankle Impingement Syndrome (Footballer’s Ankle)?
Anterior just means “front”, impingement means “pinch”, so it’s a pinching of the ankle in this area.
There is Often a Spur at the Ankle Joint
This pain at the front of the ankle joint is also called footballer’s ankle, football in the sense of soccer, because soccer players that kick a lot of balls over a lot of years can develop bone spurs from the pressure of the ball hitting the front of the ankle. There are many other causes of ankle spurs, but this is a common one.
Ankle spurs can occur either on the front of the tibia bone (the bottom of the leg bone) or on the top of the ankle bone (the talus). I show these locations in the video and on the picture. The yellow arrow points to the spur on the ankle bone.
Those spurs can compress together which causes pinching between those the tibia and the talus bones, particularly when you walk and your leg bends forward over your foot. The red arrow points to the area where the pinching or compression occurs on the front of the ankle.
This ankle compression can cause a lot of pain across the very front of the ankle. The pain can present in number of ways – it can cause achiness in that area, sharp pain or burning pain.
Hills Can Increase Ankle Impingement Pain
Often the pain is worse when you walk or run up hills. When going up a hill there is a more acute ankle between the leg and the foot which really causes a lot of pinching between the tibia and the talus that really pinches those areas together.
Ankle Impingement Sometimes Causes a Feeling of the Ankle Catching
It can cause a feeling of clicking or catching in that region, also. Sometimes, you’ll feel it when your ankle goes back like that because these areas are already inflamed and that tugs on those inflamed structures.
X-rays Used to Diagnose Ankle Bone Spurs
This is a problem that requires x-rays for diagnosis. but if you suspect that you might have anterior ankle impingement there are some home treatments you can try first to see if you can get eliminate the ankle pain before you go in and get an x-ray.
Home Treatment of Front of Ankle Pain
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Use a Heel Lift for Front of Ankle Pain
The first thing you can do to treat this problem is put a little lift under your heel. As demonstrated in the video if we just lift up the heel we actually move the tibia bone farther away from the talus bone (the ankle bone) which puts more space between the tibia and the talus.
We recommend using an adjustable heel lift. These lifts can be adjusted from 9mm down to 3mm. Start with the highest lift that will fit in your shoe and see how your pain responds. After a week try decreasing it. In the long run use the lowest lift that provides maximum relief.
Shoes for Pain at the Front of the Ankle
The type of shoe you wear can make a big difference too. I see a lot of runners with this type of pain, and often what we’ll see is they’re wearing a shoe that has a lower drop. A low drop shoe is one where the heel and the front of the foot are at about the same level. If they are on exactly the same level that is called a zero-drop shoe.
If you instead use a shoe with a greater drop that will lift up the heel and, once again, what that does is it decreases compression between the leg bone and the ankle bone. If that bone spur is present, it can really get rid of that pain quite effectively.
The Brooks Addiction Running Shoe is a great shoe with a 1cm drop that works well for a lot of walkers and runners.
The Brooks Addiction Walker is a leather walking shoe with otherwise the same features. Either shoe will work to help anterior ankle pain
Prefabricated Orthotics for Front of Ankle Pain
The other thing that works quite well is to use an orthotic device to stop your foot from rolling in. This also helps decrease compression between the talus and the tibia.
You can start with a good over-the-counter arch support. One of our favorites is the FootChair Adjustable Arch Height Orthotic. This is a very unique orthotic as it has a supportive arch which is very adjustable using pads that can be inserted under the cover. These OTC orthotics incorporate many features otherwise found only in custom orthotics and run usually under $50. We can also modify these in our clinic to make them work even better for your specific foot problem.
Use Arch Support Sandals with Heel Lift in the House
For the first 3-4 weeks of treatment you should not take a single step without heel lift and arch support. In the house it is often easier to use sandals or slippers with these features built-in.
Medical Treatment of Front of Ankle Pain
You can try the home treatments for a few weeks, but if you are not seeing improvement within three weeks seek out a podiatrist who specializes in sports medicine. A good sports medicine podiatrist can give you a definitive diagnosis and offer you a personalized treatment plan.
Custom Orthotics for Anterior Ankle Impingement
Professional medical treatment may include a custom orthotic that conforms very, very close to the arch of the foot in order to provide more stability to the foot and ankle.
We recommend trying the prefabricated orthotics first as they are much less expensive, but if that doesn’t work a custom orthotic can often provide more relief. You can learn about the cost of orthotics here.
The key with the custom orthotics, again, they really need to conform close to the arch of the foot and they need to cup around the heel to stop your heel from rolling in. I see a lot of orthotics made that just don’t give adequate support.
Is Surgery Ever Needed for Front of Ankle Pain?
Most of the time, pain at the front of the ankle can be treated non-surgically. Occasionally, the bone spurs are so large that those spurs do need to be removed in order to relieve all of the pain.
It is our opinion that surgery should be considered only as a last resort.
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