What Is Ankle Impingement, and Why Does the Front of My Ankle Pinch?
Ankle impingement is a pinching of bone or soft tissue inside the ankle joint. It usually happens at the front (anterior) when you bend your foot upward, or at the back (posterior) when you point it down. Bony spurs, scar tissue or an extra bone called an os trigonum can all be the cause. Standing, weight-bearing imaging shows whether the joint space narrows under real load.
Key takeaways
- Anterior ankle impingement causes a sharp pinch at the front of the ankle during squatting or going upstairs.
- Posterior ankle impingement pinches the back of the ankle when you point your foot, common in dancers and footballers.
- Lying-down scans relax the joint and can miss the narrowing that causes symptoms under your body weight.
- A standing, weight-bearing image captures bone spurs and joint-space changes in the position that actually hurts.
- Accurate imaging helps your clinician plan the right next step, from physiotherapy to surgery.
What is ankle impingement?
Ankle impingement is the trapping, or "pinching", of tissue inside the ankle joint when you move your foot through its full range. Bone, cartilage, scar tissue or a small extra bone can get caught between the two main ankle bones (the tibia and the talus), blocking normal movement and causing a sharp pain.
There are two main types, defined by where the pinching happens.
Anterior ankle impingement
This is the more common type, sometimes called "footballer's ankle." Bony spurs grow on the front edge of the tibia or the top of the talus. When you pull your foot upward (dorsiflexion), these spurs meet, creating a hard block and a sharp pinching pain at the front of the ankle. Scar tissue from old sprains can add to the problem.
Posterior ankle impingement
This affects the back of the ankle. It is common in dancers who go en pointe and in footballers who repeatedly strike a ball. The pain comes when you point your foot fully downward (plantarflexion). An extra bone at the back of the talus, called an os trigonum, is often involved. This small bone gets trapped between the talus and the heel bone.
What does ankle impingement feel like?
The symptoms depend on whether the front or the back of the ankle is affected, but a few features are shared across both types.
A precise, pinching pain at the front or back of the ankle, not a general ache.
The ankle feels like it hits a wall. Squatting, lunging or going en pointe becomes difficult.
Mild puffiness around the joint after sport or walking, often at the front of the ankle.
Going upstairs or walking uphill forces the ankle into the range where the pinching is worst.
A note on soft tissue. EOS and X-ray imaging show bones, joints and alignment clearly. If your clinician suspects the impingement is mainly from scar tissue, inflamed synovium, or a tendon problem such as peroneal tendonitis, MRI is usually the better tool for soft-tissue detail. The two types of imaging often work best together.
What causes ankle impingement?
Ankle impingement develops when repeated stress leads to bony or soft-tissue changes inside the joint. The most common triggers include the following.
Old ligament injuries leave scar tissue and thickened tissue that gets caught in the joint.
Repeated loading, especially kicking a football, stimulates bone growth at the joint edges.
A small extra bone behind the talus, present from birth, that gets trapped at the back of the ankle.
Activities that push the ankle to extremes of movement, like going en pointe or repeated kicking.
Your body is a connected chain. When ankle movement is blocked, the knee, hip and lower back often compensate. Reduced dorsiflexion at the ankle, for example, can push the knee inward (valgus) during squatting. This is why pain sometimes shows up in a different joint entirely.
How does a standing scan show ankle impingement?
A standing, weight-bearing image captures your ankle under real load, which is the condition that causes the pinch. Lying-down X-rays relax the muscles and decompress the joint, so bony spurs may look separate from each other even though they collide when you stand.
With your full body weight pressing through the ankle, the joint space narrows to its real working size. Bony spurs that contact each other under load are clearly visible, and the clinician can measure how much movement the joint truly has. At ScanAlign, weight-bearing standing imaging uses EOS technology with about 90% less radiation than a standard X-ray, around ten times less.
Without body weight, the joint opens up. Spurs that pinch badly during daily life may appear separated and harmless. The scan is a snapshot of a relaxed position your ankle is rarely in, so it can understate the problem.
Because the whole body is imaged in a single standing capture, your clinician can also see whether a blocked ankle is affecting alignment further up the chain, at the knee, hip or spine.
Want to see your ankle under real load? You can book a weight-bearing ankle scan or start with a free video consultation to discuss your symptoms first.
Book a free video consultationWhat can be done about ankle impingement?
Treatment depends on the type and severity. ScanAlign is a diagnostic imaging clinic, not a treatment provider, so the role of imaging is to give your treating clinician a clear, weight-bearing picture so they can plan the right approach for you.
Common directions your clinician may consider include:
- Physiotherapy and mobility work to improve dorsiflexion and reduce compensatory patterns in the knee and hip.
- Activity modification to reduce repeated end-range loading while the joint settles.
- Injection therapy guided by imaging, to reduce inflammation inside the joint.
- Arthroscopic surgery to remove bony spurs, scar tissue or an os trigonum if conservative approaches have not helped.
Accurate imaging is the starting point. A weight-bearing view helps your clinician decide which of these options fits your situation.
- Have a pinching pain at the front or back of your ankle during sport or daily life
- Feel your ankle movement is restricted and past X-rays look normal
- Are a dancer, footballer, or runner with worsening ankle pain
- Have knee or hip pain that may be linked to a stiff ankle
- A sudden inability to bear weight after an injury
- Numbness, tingling or weakness in your foot
- A visibly deformed ankle or severe swelling after a fall
- Signs of infection: redness, heat and fever around the joint
Frequently asked questions about ankle impingement
Yes. "Footballer's ankle" is a common name for anterior ankle impingement. It refers to bony spurs that form at the front of the ankle joint, often from repeated kicking or dorsiflexion loading.
An os trigonum is a small extra bone that sits behind the talus. Some people are born with it and never have symptoms. In others, it gets pinched between the talus and the heel bone during plantarflexion, causing posterior ankle impingement.
It can contribute. When dorsiflexion is restricted, the knee may collapse inward (valgus) during squatting or walking. Over time this compensatory pattern can lead to knee discomfort, which is why whole-body alignment imaging can be valuable.
No. ScanAlign is a private, self-pay clinic. You can refer yourself. A free video consultation is available first so that a specialist radiographer can check that the scan is appropriate for you.
An EOS scan delivers about 90% less radiation than a standard X-ray, around ten times less. This makes it a very low-dose option for detailed bone and alignment imaging.
When you stand, your body weight compresses the ankle joint to its real working size. Bony spurs that appear well separated on a lying-down X-ray may actually contact each other under load. A standing image shows the joint as it functions in daily life.
Soft-tissue impingement from mild inflammation may settle with rest and physiotherapy. Bony spurs and an os trigonum are structural and do not resolve on their own, though symptoms can sometimes be managed without surgery.
Impingement is a pinching at a specific point in the range of movement. Arthritis involves more widespread cartilage loss and typically causes stiffness and aching throughout the joint. The two can overlap, especially when long-standing impingement accelerates wear.
Scan pricing is listed on the ScanAlign FAQs page. You can view current costs and what is included there.
The scan provides detailed diagnostic information. Whether surgery is needed is a clinical decision made by your treating consultant, using the imaging alongside your symptoms and examination. ScanAlign does not recommend or provide treatment.
See your ankle under real load
A free video consultation lets you discuss your symptoms with a specialist radiographer before deciding whether a scan is right for you.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Tol JL, van Dijk CN. Anterior ankle impingement. Foot and Ankle Clinics. 2006;11(2):297-310.
- Ribbans WJ, et al. Os trigonum syndrome. Foot and Ankle Surgery. 2015;21(2):74-81.
- NHS. Ankle problems overview. nhs.uk. Available at: https://www.nhs.uk/conditions/ankle-pain/
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.