Pain On Front Of Ankle? Treatment For Anterior Ankle Impingement

What Causes Pain On Front Of Ankle?

Before we get started, it's important to go over the anatomy of the ankle.

Your ankle is made up of four bones:

1. Tibia - your inner leg bone
2. Fibula - your smaller outer leg bone
3. Talus - wedge-shaped bone with a dome on top
4. Calcaneus - you heel bone

Additionally, your ankle has 3 joints:

1. Inferior tibiofibular - joint between bottom of the tibia and fibula.
2. Talocrural - joint between the talus and tibia/fibula (mortise)
3. Subtalar - joint between the talus and calcaneus

The talocrural joint allows mostly upward (dorsiflexion) and downward (plantarflexion) motion of the foot.

Conversely, the axis of the subtalar joint is at approximately a 45-degree angle, which allows motion along all three planes.

Motion at this joint is referred to as prontation (foot flattening) and supination (arch raising).

This will be important to know later in the joint.

Now onward to causes of front of the ankle pain.

Front Of Ankle Pain From Osteochondral Fracture

The most severe but least common cause of pain on the front of the ankle is an osteochondral fracture of the talus.  That's a fracture through the cartilage and bone of the dome of the talus.

An osteochondral fracture can happen due to a fall from a height or a severe ankle sprain. Unfortunately, osteochondral fractures often require surgery to heal fully.

However, if you had one, you would have had a severe traumatic injury that hurt your ankle immediately.

Front Of Ankle Pain From High Ankle Sprain

The next most severe cause of front of ankle pain can also result from a severe ankle sprain, especially one where you go into excessive dorsiflexion.

In this case the talus gets jammed between the tibia and fibula causing a sprain of the ligament and potentially membrane holding the two bones together.

Treatment for a high ankle sprian

The best treatment for that is to brace it.

Usually, high ankle sprains, as they're called, take a long time to heal.

The most common symptom is pain on front of the ankle just above the bumps (malleoli) of the tibia and fibula.

A key factor with a high ankle sprain, you don't want to stretch in the acute phase.

Now, after you've been in a brace for a while, you may need to stretch because you've gotten stiff. But bracing in the short term is the best treatment for a high ankle sprain.

Oftentimes, an Aircast brace that kind of goes around your ankle like a stirrup and has straps that compress your tibia and fibula together is the best option.

However, if you have just a lace-up ankle brace, try that first.

Just put it on tight enough compresses the tibia and fibula together.  Just don't make it so tight that your feet get cold or numb.

If that doesn't work for you, then try the Aircast brace.

Front Of Ankle Pain From Anterior Ankle Impingement

Next, the most common but least severe thing that causes pain on front of the ankle is something called anterior ankle impingement.

What that means is that you pinch the front of the talocrural joint as you go into dorsiflexion.

The talus is too far forward in the mortise of the tibia and fibula, so as your knee goes more forwards over your toes, you get more pinching.

This is common in activities such as going down stairs, squatting, or running.

Well, in that case, what you really need to do is get that talus to glide more backwards in the socket.

What Causes Anterior Ankle Impingement?

How does the talus get too far forward in the first place?

When you have a severe ankle sprain, you often sprain a ligament on the side of your ankle called the anterior talofibular ligament.

The anterior talofibular ligament attaches from the fibula to the talus and it prevents that talus from gliding too far forwards in the talocrural joint.

However, if you've had a really severe ankle sprain where you've torn that ligament, or if you've had many ankle sprains where you've repeatedly stretched it out over time, then that ligament no longer does a good job of holding the talus securely in the socket.

And so the talus can creep forwards and can cause pain on the front of the ankle when squatting, going down stairs, or running.

Treatment For Anterior Ankle Impingement

The easiest way to fix that is actually seeing a physical therapist and getting an ankle joint manipulation.

However, if you've had repeated ankle sprains and overstretched your anterior talofibular ligament, it is quite possible that your talus may glide forward again in the future.

So it's helpful to be able to do a self-mobilization to be able to control your ankle symptoms on your ow.

How do you do self-treat your ankle impingement?

You can put your foot up on a chair a towel or a stretching strap around the front of your ankle.

Pull backwards on the towel, and that pulls the talus backwards in the socket.

Then bring your knee forwards in front of your toe while pulling backward with the towel.

Make sure to keep your heel on the chair.

You can also do this exercise with your foot on a stair instead of a chair. This may be a good option for people with knee arthritis. That way, you don't need to bend your knee as much.

How To Prevent Anterior Ankle Impingement

As I mentioned, once you've sprained your anterior talofibular ligament, you may get front of ankle pain again in the future.

That's because you don't have any muscles that attach directly to the talus.

Therefore, there's no way that you can strengthen muscles to pull the backward in the socket.

So what do you do about that?

Well, if you remember earlier I mentioned the subtalar joint axis is a 45-degree angle.

That allows you to get some dorsiflexion at your ankle by overpronating your foot.

However, that's not good for a number of reasons.

Overprontation can cause plantar fasciitis or Achilles tendonitiss, knee pain, hip pain, or even lower back pain.

The issue at hand in this post is though that if you're getting your dorsiflexion from the subtalar joint (which isn't ideal), then you're not getting it from the talocrural joint.

And if you're not dorsiflexing at the talocrural joint regularly, then you're subject to getting front of ankle pain again in the future.

Recall that there are no muscles that pull the talus back into the socket.  Therefore, the next best thing you can do is prevent overpronation at that subtalar joint.

Single-leg balance exercise

To do that, practice balancing on one leg, keeping the arch of your foot lifted.

You don't want to allow your foot to flatten or pronate because then you're encouraging subtalar dorsiflexion.

But what you really want is talocrural joint dorsiflexion.

Single-leg minisquat exercise

Once you've mastered standing on one leg with your arch lifted, then you can start one-legged mini-squats.

This exercise helps you improve talocrural joint dorsiflexion. That will help you go down stairs without getting pain on the front of  your ankle.

When to Seek Treatment For Pain On Front Of The Ankle

Hopefully, you found this article helpful to better understand your front of ankle pain as well as to self-treat it.

As I mentioned previously, there are some really effective in-person treatments such as ankle joint manipulation that we can do for you here at More 4 Life.

So if you've tried the treatments on this page, or if you just need help for your ankle pain as quickly as possible, tap the button below to request an appointment with one of our specialist physical therapists.

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