Ankle impingement is a mild medical condition in which the soft tissues or bones in the ankle are compressed and cause an individual to experience pain.
Repetitive compression of the ankle or excessive strain may exacerbate the impingement and eventually cause degradation of the soft tissues of the ankle or lead to more severe conditions such as bone spurs, muscle tears, arthritis, and tendonitis.
There are several underlying causes for ankle impingement as well as treatment methodologies for restoring function to this vital part of the body once the issue has been injured.
Understanding the causes, how they express themselves in the injured tissue, and the treatment options available is the first step in reducing the impact ankle impingement will have on a patient.
Anatomy of Ankle Impingement
The ankle is the meeting point between the bones, muscles, and soft tissues at the base of the foot and those of the lower leg. In ankle impingement, the major cause of pain is the bones which pinch the soft tissues of the ankle between them. These bones include the:
- Fibula and tibia
- Large bones of the lower leg
- The major bone beneath the fibula and tibia
- The bone directly under the talus located at the base of the foot
Healthy interaction between these bones leaves ample room for the soft tissues of the lower leg and foot. This space is necessary in order to ensure that these soft tissues receive an adequate supply of blood and oxygen, if they lose this supply or if the chain is disrupted, the soft tissues send signals to the brain to indicate an abnormality.
Thus, when the bones of the ankle interact abnormally, they compress the soft tissues of the lower leg and foot and induce bouts of pain.
Anterior vs. Posterior Ankle Impingement
The ankle is comprised of several groups of soft tissue which weave throughout bone. The soft tissues located directly at the front or back of the ankle are the most likely to become compressed during flexion and thereby induce a state of ankle impingement. Depending on the location of the compression and injury, a doctor will diagnose an individual with either anterior (front) or posterior (back) ankle impingement.
Those who suffer from anterior ankle impingement will often experience:
- Tenderness at the front of the ankle
- Ankle instability or decreased load bearing capacity
- Limited range of ankle motion, especially when stretching the foot toward the shin
- Pain around the ankle joint, especially on the front of the ankle
- Flare-up of pain at the end-range of stretching the foot toward the shin
- Clicking sensations during ankle movement
Posterior ankle impingement expresses itself as:
- Tenderness at the back of the ankle
- Ankle instability or decreased load bearing capacity
- Limited ankle range of ankle motion when pointing toes away from shin
- Pain around the ankle joint, especially at the back of the ankle
- Flare-up of pain at the end-range of motion when stretching foot away from shin
- Clicking sensations during ankle movement
The severity of these symptoms and their frequency can give doctors a good idea of the current state of an individual’s ankle impingement. When these issues occur, it is best to log them and track their development in order to give doctors some guidance as they proceed in treating the issue.
Causes of Ankle Impingement
Both types of ankle impingement, anterior and posterior, are likely the result of the same circumstances. The most probable causes of ankle impingement are:
- Ankle injury such as:
- Ankle sprains
- Ankle trauma
- Repeated flexion and compression of the ankle such as:
- Strenuous physical activity
- Repetitive, excessive load bearing
Repetitive flexion or compression, coupled with excessive load, can cause abnormalities in the everyday movements of ankle. By breaking down the soft tissues or weakening the muscles which are located in ankle, these habits put strain on portions of the body which are not accustomed to dealing with the extra load. Habitually practicing these behaviors such as in sports or an active job, makes an individual more prone to being diagnosed with ankle impingement.
Other contributing factors which may predispose an individual to ankle impingement include:
- Poor balance
- Tight muscles
- Joint swelling
- Faulty foot biomechanics (flat feet and high arches)
- Insufficient recovery periods from bouts of physical exertion
- Inadequate warm-up
- Bodily anomalies (bone spurs, muscle deficiencies)
- Inappropriate training (wrong technique or footwear)
- Excessive training
Overtime, these causal factors take their toll on the ankle’s biomechanics and composition and lead to ankle impingement and pain. As this pain develops, an individual should begin seeking out medical consultation in order to understand what causes the pain, how to avoid it, and how to recover from it once it is present.
Diagnosing Ankle Impingement
While the symptoms may be enough to help an individual determine that their ankle has a problem, an adequate ankle impingement diagnoses should be made by a trained professional. Using specially crafted techniques and equipment, doctors will be able to not only determine the location and severity of the issue, but also how best to treat it.
A good consultation will begin with an examination of the patient’s medical history and assessment of the findings. Doctors will look out for any past injury involving the leg as well as the rehabilitation methods used. This research may not seem like much but can give doctors enough of an idea of current composition of the ankle to understand what to look for in their diagnoses. While medical history is enough to give a good indication of the current state of the ankle, doctors will usually conduct a physical examination after their research.
The patient will be asked to extend their ankle to its outer limits to test its range of motion. Patients will point the toes of the foot away and then towards the shin as a doctor palpates the ankle. The doctor will try to feel for abnormalities in the movement and may at times apply enough pressure to induce pain so as to figure out the location and type of ankle impingement being experienced.
Following a physical examination, the doctor will conduct diagnostic imaging on the patient in order to get an inside look at the biometrics of the ankle. A standard radiograph will be conducted to capture of image of the bones in the ankle from the side. This profile will be examined for abnormalities such as weakened cartilage and bone spurs.
Once these examinations are complete, the doctor should have enough insight to properly diagnose the patient with either posterior or anterior ankle impingement. The doctor will follow the diagnosis up with an array of treatment options.
Conventional Treatment Options for Ankle Impingement
Once an individual is diagnosed with ankle impingement, a doctor will work with them to prepare a rehabilitation plan suitable to their lifestyle. The plan may involve a number of conventional treatments which will work together to help an individual achieve their functional goals and return to the activities they once enjoyed albeit pain free. A typical plan will involve one or more of the following options.
Rehabilitation will most likely begin with a physical therapy regimen. Physical therapy will try to reduce the pain felt by the patient, increase their range of motion and muscle strength, and retrain the patient’s biomechanics.
A physical therapist may use a number of methods to reduce the pain felt by the patient. Massage, compression, and electrical stimulation are some of the most popular methods PTs use to help reduce inflammation and reduce the effects of ankle impingement.
In addition to attempting to reduce pain, the PT may administer a routine of range-of-motion exercises to practice in order to help teach a patient the proper motions to move through in order to increase their mobility and decrease ankle stiffness. PTs may even perform joint mobilization therapy in which they move the ankle joint in particular directions in order to improve its motion.
A big part of physical therapy is muscle-strengthening exercise. By increasing the muscle mass surrounding the ankle, the injured tissues have less load to bear. With less of a constant strain placed on the ankle, the effects of the impingement are reduced and the patient experiences “softer” bouts of pain.
Another tactic PTs use in addition to those mentioned above is biomechanical restructuring. By changing the way in which a patient moves, they can achieve their functional goals quicker than if they continue their normal, strenuous movements. PTs achieve this restructuring by training patients to be more aware of their centers of gravity. By improving the balance a patient has, they can be more aware of where they are placing their weight and try to avoid motions which flare-up the pain caused by their ankle impingement.
If pain is persistent and interferes with the daily routines of a person’s life, doctors may recommend medication. These medications will aim at decreasing inflammation caused by ankle impingement as well as numbing the ensuing pain. While it is not an ideal solution, both due to the potential side-effects of each medicine and the present dangers of addiction therein, medication does allow a patient to experience almost immediate relief from any ankle pains they are experiencing.
Cortisone injections are among the most commonly used treatments in degenerative illnesses such as some cases of ankle impingement. These injections provide immediate relief from pain by reducing swelling in the injured tissues. While they are one of the most popular treatment methods, cortisone injections present the risk of cartilage damage and tendon rupture which may lead to further complications later on.
Surgery is typically reserved as a last resort for ankle impingement. It can be highly invasive as well as ineffective, requiring multiple surgeries in order to return minimal function to the effected area. Coupled with the fact that surgery will most likely require physical therapy anyway, surgery is an imperfect solution to the problems caused by ankle impingement.
Recovery time is a major component of an individual’s choice when selecting a treatment for their ankle impingement. While conventional options are the most trusted by the medical community, new therapies are emerging which drastically reduce this recovery time and help make ankle impingement less of a disruption.
Regenerative Medicine for Ankle Impingement
Recent discoveries in the field of regenerative medicine have paved the way for their use as a tool in combating the problems faced by those suffering from ankle impingement. In addition to reducing pain, decreasing inflammation, and restoring damaged tissue, regenerative medicines can also help to reduce the recovery time for individuals with ankle impingement. At CELLAXYS, we offer two regenerative treatment methods to help reduce the impact ankle impingement has on a person’s lifestyle.
Platelet Rich Plasma (PRP) Therapy
Platelet Rich Plasma (better known as PRP) therapy involves extracting a patient’s blood, processing it, and then reinjecting it into the source of pain, in this case, the ankle. By harvesting blood directly from the patient, doctors ensure that the treatment won’t be rejected by the patient’s body.
After it is harvested, the blood is spun through a centrifuge in order to isolate the platelets within it. These platelets contain a number of growth factors which are used to help the body heal. Once injected, these platelets produce chemical signals which draw the body’s natural healing factors to the site of the injury and speed up the healing process.
PRP has been proven to reduce pain in muscles, tendons, and cartilage.
Stem Cell Therapy
Similar to PRP therapy, stem cell therapy’s active ingredients are produced by extracting tissues directly from the patient. Typically, doctors will extract bone marrow or fat and process these materials into what are known as mesenchymal stem cells. These cells are able to amplify the body’s healing factors and provide a suitable environment in which those healing factors can work.
Doctors will often use MRI technology to accurately place the stem cell injections into the site of ankle impingement. After an accurate placement of the stem cells, the ankle may experience mild swelling as the body begins to react to the injection. This swelling typically goes away within a few days and the injections continue to work for months thereafter. Stem cells signal the body to send healing and growth factors towards the site of injection and then create an atmosphere suitable for the body to repair itself. In the process, damaged soft tissues are restored and pain is reduced.
Ankle impingement can become a serious issue for individuals who suffer from it. Soft tissues can get destroyed, nerves pinched, and bones can develop spurs.
As the effects continue, pain can become so severe that an individual may become immobilized.
While there are many suitable conventional treatment methods, only stem cell and PRP therapies can reduce the pain and inflammation while restoring tissue and minimizing recovery time.
CELLAXYS aims to provide an informational, comfortable environment for those seeking alternative measures to their ankle impingement. Contact one of our representatives today to set up a consultation.