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Ankle impingement occurs when soft or bony tissues become compressed within the ankle joint at the extreme end of a motion. It often affects people who experience forces through the ankle at extreme positions, such as dancers, gymnasts, football players, or athletes who do kicking motions. Also, people who do repeated tasks that involve squatting or stair-climbing are prone to this condition. Physical therapists help people with ankle impingement reduce pain, heal, strengthen the affected area, and improve overall balance.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

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What Is Ankle Impingement?

There are two types of ankle impingement:

  • Anterior (front) ankle impingement.
  • Posterior (back) ankle impingement.

Anterior ankle impingement. This injury causes pain on the front side of your ankle. This type of ankle impingement can result from:

  • Inflammation and swelling. These conditions can occur due to repeated stress at end-range positions of the ankle (when the foot is fully flexed upward with toes pointed toward the shin or extended downward with toes pointed toward the sole of the foot), such as when jumping, squatting, or going down stairs. This can lead to inflammation and swelling and the development of bone spurs (a bony overgrowth) in the ankle joint space.
  • Ankle instability. This condition is a looseness of the ankle joint that develops after repeated ankle sprains. These sprains cause damage to ankle ligaments. The damage can result in compressed tissue and scarring that takes up more joint space. This causes pain during activities that require stretching your toes up toward your shin (ankle dorsiflexion). Examples of these activities include squatting, jumping, and climbing stairs.

Posterior ankle impingement. This injury causes pain on the back of your ankle, especially during activities that involve pointing your toes. It can result from:

  • Compression of soft or bony tissue between the shin bone (tibia) and the heel bone (calcaneus). There are numerous soft tissue structures that could cause posterior impingement. Some people have a small extra bone in the back of their ankle called the Os Trigonum. This little bone can lead to impingement in the back of the ankle, and pain. It causes compression between the shin bone and the heel bone when the foot is pointed.
  • Excess force on the ankle. Large amounts of force on the ankle sometimes can cause small pieces to break off of the ankle bone. This leads to compression when moving the foot or toes downward toward the sole of the foot (plantar flexion). The compression causes tissue inflammation and swelling that leads to pain.

Signs and Symptoms

With anterior ankle impingement, you may experience:

  • Pain on the front and/or outside of the ankle joint.
  • A feeling that the ankle is unstable.
  • Decreased ankle range of motion when stretching your toes up toward your shin.
  • Pain at the end-range of stretching your toes toward your shin.
  • Tenderness at the front of the ankle when touched in end-range positioning.
  • Pain at the end range of stretching your toes toward the ground in front of the ankle.

With posterior ankle impingement, you may experience:

  • Pain on the back of your ankle, especially during activities that involve pointing your toes.
  • Decreased range of motion when pointing your toes.
  • Tenderness on the back of the ankle when touched.
  • Clicking, popping, or catching of the ankle when attempting to point your toes.
  • Increased pain when standing up, or pushing off during walking.

How Is It Diagnosed?

Your exam will begin with questions about your personal health history and current symptoms. Your physical therapist will ask you when your symptoms began, the location of your pain, and what activities cause your pain. They will perform a physical exam to evaluate your:

  • Ankle strength.
  • Range of motion.
  • Sensation (ability to feel).
  • Structural stability.
  • Balance.

Your physical therapist also will perform special tests such as gently moving your ankle to see if it causes symptoms.

To diagnose posterior ankle impingement in dancers, the exam may be geared to that activity. For example, a physical therapist may ask a ballet dancer to demonstrate the en pointe position, which involves standing on the tips of the toes.

To provide a definitive diagnosis, your physical therapist may team with an orthopedic doctor or other health care provider. The most accurate method to diagnose ankle impingement is by X-ray or MRI, which can be ordered by your doctor.

How Can a Physical Therapist Help?

A physical therapist performs strength testing on a woman's ankle.

Your physical therapist will work with you to achieve your functional goals. They will help you return to your prior activities without pain. Your treatment may include:

Pain management. Your physical therapist may use ice, massage, or electrical stimulation to help lessen pain and inflammation. They may recommend that you reduce your activity level for a while to allow the inflammation in your ankle to decrease.

Range-of-motion exercises. Your physical therapist may gently move your ankle through its available range of motion. They also may teach you the proper motions to move through to increase mobility and decrease stiffness. If needed, your physical therapist may perform joint mobilizations to skillfully move your ankle joint in a specific direction to improve its motion.

Muscle-strengthening exercises. It is important to strengthen the muscles of the foot, ankle, and lower leg to promote proper joint mechanics. When the muscles are strong and working properly, the joint space in the ankle is maintained. This decreases the risk of compression of soft or bony tissues.

Balance exercises. Your physical therapist may teach you balance exercises to challenge the way your body reacts to outside forces. These exercises make you more aware of where your body is in space. Improving balance will lead to a more stable ankle, because your body can more easily respond to challenges.

Functional training. Once your physical therapist has helped decrease your ankle pain and inflammation, you will move on to more activity-specific tasks. Your physical therapist will help ensure that your ankle can withstand challenges during work, sport, or performance activities.

Can This Injury or Condition Be Prevented?

There is no way to completely prevent an injury. However, there are some actions that active and at-risk people can take to reduce the risk of ankle impingement. These include:

  • Using correct techniques when doing physical activities.
  • Wearing proper footwear. For example, basketball players can wear high-top shoes to improve ankle stability.
  • Avoiding overtraining. Repeated stresses and overuse tend to bring on conditions like ankle impingement.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of injuries and conditions. However, you may want to consider:

  • A physical therapist who is experienced in treating people with ankle impingement. Some physical therapists have a practice with an orthopedic or sports focus.
  • A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists in your area with these credentials and clinical expertise on Find a PT, a tool built by the American Physical Therapy Association.

General tips when you're looking for a physical therapist (or any other health care provider):

  • Get recommendations from family, friends, or other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapist’s experience in helping people who have ankle impingement.
  • Be prepared to describe your symptoms in as much detail as possible during your first visit. Make a note of what makes your symptoms better or worse.

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The American Physical Therapy Association believes that consumers should have access to information to help them make informed decisions and prepare them for their visit with a health care provider.

The following resources offer some of the best scientific evidence related to physical therapy treatment for ankle impingement. They report recent research and provide information on the standards of practice both in the United States and internationally. They link to a PubMed* abstract (which may also offer free access to the full text) or other resources. You can read them or print out a copy to bring with you to your health care provider.

Ishibashi MA. Posterior ankle impingement syndrome. Clin Podiatr Med Surg. 2023;40(1):209–222. Article Summary in PubMed.

Ivanova V. Dance-related foot and ankle injuries and pathologies. Clin Podiatr Med Surg. 2023;40(1):193–207. Article Summary in PubMed.

Iafrate JL. Diagnosis and management of foot and ankle injuries in dancers. Curr Phys Med Rehabil Rep. 2021;9:47–56.

Diniz P. Diagnosis and treatment of anterior ankle impingement: state of the art. J ISAKOS. 2020;5(5):295–303.

Sharpe B. Posterior ankle impingement and flexor hallucis longus pathology. Clin Sports Med. 2020;39(4):911–930. Article Summary in PubMed.

Kadel N. Foot and ankle problems in dancers. Phys Med Rehabil Clin N Am. 2014;25(4):829–844. Article Summary in PubMed.

Talusan PG, Toy J, Perez JL, et al. Anterior ankle impingement: diagnosis and treatment. J Am Acad Orthop Surg. 2014;22(5):333–339. Article Summary in PubMed.

Albisetti W, Ometti M, Pascale V, De Bartolomeo O. Clinical evaluation and treatment of posterior impingement in dancers. Am J Phys Med Rehabil. 2009;88(5):349–354. Article Summary in PubMed.

van Giffen N, Seil R, Pape D, Nührenbörger C. The athlete's foot: the grey zone behind the ankle. Bull Soc Sci Med Grand Duche Luxemb. 2009(1):57–65. Article Summary in PubMed.

Umans H. Ankle impingement syndromes. Semin Musculoskelet Radiol. 2002;6(2):133–139. Article Summary in PubMed.

*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.