How to Manage Ankle Impingement, According to Physical Therapists

Have you ever felt a sharp, pinching pain around your ankle when you walk, run, or stand on your tiptoes? If so, you know how much of a bother it can be. Ankle pain can disrupt your daily routine and throw off your workout regimen. There are many reasons why your ankles may hurt — overuse, a mild sprain, or even arthritis. Another culprit is a condition known as ankle impingement.

“When you have ankle impingement, your joint tissue swells, which can cause pain and affect your range of motion,” explains Vanessa Matos, PT, DPT, a physical therapist at Hinge Health. It mainly occurs among athletes, which is why it’s sometimes known as footballer’s ankle. But it can happen to anyone. 

Fortunately, with the right approach, including targeted exercises and maybe some activity modifications, most people can find relief without the need for invasive treatments. Here’s a closer look at ankle impingement: what it is, what causes it, and treatments recommended by Hinge Health physical therapists, including ankle impingement exercises.

What Is Ankle Impingement?

Ankle impingement is a condition where the soft tissues — ligaments, tendons, bursae, or muscles — get compressed in your ankle joint, says Dr. Matos. “It’s usually between two bones, and is due to repetitive stress, an ankle trauma, or some sort of structural or anatomical difference,” she explains. While it’s not very common, it’s more likely to occur among athletes, she notes. There are two different types of ankle impingement:

• Anterior ankle impingement. This is where the tissues at the front of the ankle get compressed between the shin bone and ankle bone. “We usually see it in athletes who have to bend their ankle upward repeatedly, like dancers, soccer players, and basketball players,” says Dr. Matos.

• Posterior ankle impingement. This occurs when the tissues at the back of the ankle are compressed between the ankle bone and heel bone. “It’s more common among athletes who repeatedly move their foot downward and away from their body, like gymnasts, dancers, and runners,” says Dr. Matos.

Ankle Impingement Symptoms

While symptoms depend on what type of ankle impingement you have, Dr. Matos says general signs of ankle impingement include:

• Pain

• Swelling

• Stiffness

• Tenderness

• Limited ankle range of motion

If you have anterior ankle impingement, you may notice:

• Pain on the front or outside of your ankle 

• A feeling that your ankle is unstable

• Difficulty and pain stretching your toes up toward your shin

• Tenderness at the front of your ankle

If you have posterior ankle impingement, you may experience:

• Pain on the back of your ankle, especially when you point your toes

• Difficulty pointing your toes

• Tenderness at the back of your ankle

• Clicking or popping sounds when you try to point your toes

• Increased pain when you stand up or push off as you walk

Ankle Impingement Causes

There are a few reasons you may develop ankle impingement. Here are some common ones. 

• Doing more than your body is ready for. Doing certain activities repeatedly, like jumping, squatting, or going down stairs, can contribute to inflammation and swelling in your ankle joint. “This can happen when your foot is fully flexed up with your toes pointed toward your shin or extended downward with your toes pointed toward the sole of your foot,” explains Dr. Matos. Stretching and strengthening exercises help prepare your body to handle repetitive movements. 

• Previous injuries. A history of injuries, such as sprained ankles, may contribute to some tissue compression and scarring. This can cause pain when you stretch your toes up toward your shin, like when you squat, jump, or climb stairs.

• Anatomical variations. “Everybody has a little bit of variation in their ankle joint, and sometimes that can predispose you to changes or injuries,” says Dr. Matos. Some people may have bone spurs, which impinge on soft tissue. “You can be born with them, or you can develop them over time,” explains Dr. Matos. Other people can have either flat feet or high arches, which can predispose them to ankle impingement. “It causes a different distribution of forces in the ankle which increases their risk,” says Dr. Matos.

• Arthritis. Osteoarthritis is the most common type of arthritis. It’s characterized by changes in the shock-absorbing cartilage around a joint that causes the bones to rub against each other. Other common forms of arthritis include rheumatoid arthritis or psoriatic arthritis, where your immune system compromises your joints. “All of these can cause swelling, inflammation, and changes to the ankle joint structure which can predispose someone to ankle impingement,” explains Dr. Matos.

One of the most effective treatments for ankle impingement pain is exercise therapy. The above exercises all improve mobility, strength, and balance. They also increase your ankle’s proprioception, or ability to sense where it is in space, says Dr. Matos. “All of these things are important to decrease ankle pain, and make sure you have good control over your ankles,” she explains. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatment Options

No matter what types of risk factors you have for ankle impingement, there are plenty of ways you can treat and get relief from ankle impingement symptoms. In addition to the exercises above, here’s what Hinge Health physical therapists recommend. 

• Physical therapy. A physical therapist can work with you to help you move your ankle through its range of motion. They can teach you exercises to increase mobility and strengthen the muscles of your foot, ankle, and lower leg. “They can also teach you balance exercises, which will lead to a more stable ankle since it can more easily respond to challenges like landing on an uneven surface,” points out Dr. Matos. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Relative rest. The key word here is relative. “We aren’t talking about hobbling around on crutches and avoiding all weight bearing on the ankle,” stresses Dr. Matos. “The goal is to modify your training to reduce excess stress on your ankle.” If you’re a runner, for example, it may mean scaling back on your jogging workouts and adding in low-impact cross-training, like swimming or biking, a few times a week. “You can still use your ankle. Just try to scale back enough that you can keep your pain level in the mild to moderate range — a three or four instead of a nine on a scale of one to 10,” advises Dr. Matos.

• Taping. Your physical therapist may recommend that you tape your ankle with elastic athletic tape to help stabilize your ankle for a few weeks. It gives additional proprioceptive feedback to your ankle. “Proprioception is basically your body’s GPS system — it tells it where each joint is in space, and how it’s moving,” explains Dr. Matos.

• Over-the-counter pain relievers. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve) can help relieve inflammation and pain. Taking them for a short time might make it easier for you to exercise and follow a physical therapy regimen that will help you in the long run, says Dr. Matos. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Wear proper footwear. Shoes that don’t fit right can put extra strain on your ankle that can worsen impingement symptoms, says Dr. Matos. This is especially important when you exercise, since running and jumping put extra impact on your lower body — including your ankles. The American Academy of Orthopedic Surgeons recommends that if you do a certain activity more than twice a week, you should purchase footwear designed for it — for example, a running shoe, hiking shoe, or cleat. If your ankle impingement is impacted at all by flat feet or high arches, an over-the-counter or custom orthotic may help, adds Dr. Matos.

PT Tip: Be Eccentric

It’s important to include eccentric training in your rehabilitation program, says Dr. Matos. “Eccentric exercises strengthen your muscles while you lengthen them,” she explains. One easy way to do this is to rise onto your toes, then slowly lower back down, taking about twice as long to come down as it did to rise up. You can add this movement several times a day while you do everyday activities. “It’s a good way to address muscle imbalances and improve ankle control,” she says.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Lavery, K. P., McHale, K. J., Rossy, W. H., & Theodore, G. (2016). Ankle impingement. Journal of Orthopaedic Surgery and Research, 11(1). doi:10.1186/s13018-016-0430-x

2. Berman, Z., Tafur, M., Ahmed, S. S., Huang, B. K., & Chang, E. Y. (2017). Ankle impingement syndromes: an imaging review. The British Journal of Radiology, 90(1070), 20160735. doi:10.1259/bjr.20160735

3. Ishibashi, M. A., Doyle, M. D., & Krcal, C. E. (2023). Posterior Ankle Impingement Syndrome. Clinics in Podiatric Medicine and Surgery, 40(1), 209–222. https://doi.org/10.1016/j.cpm.2022.07.014

4. Armstrong, T., Rowbotham, E., & Robinson, P. (2023). Update on Ankle and Foot Impingement. Seminars in Musculoskeletal Radiology, 27(03), 256–268. https://doi.org/10.1055/s-0043-1764387

5. Weatherford, B. M. & Irwin, C. K. (2019, April). Athletic Shoes. American Academy of Orthopedic Surgeons. Retrieved from https://orthoinfo.aaos.org/en/staying-healthy/athletic-shoes/