What should I do for anterior ankle impingement affecting my running?

Doctor's Answers 3

It sounds like you want to go back to running – is this correct?

I agree with my colleagues that the mainstay of treatment for this is physiotherapy or perhaps a surgery. This is of course depending on the cause of impingement, which by what you have written, doesn’t seem to have been identified? Thus it leads me to ask what IS the cause?

As Dr Alan has written, there can be many different aetiologies (causes) from an anatomical perspective, but in your case could it be more functional?

If so, another thing to consider is your gait, running pattern and footwear choices. Depending on how you strike the ground while you are running and your choice of footwear, it might be placing additional pressure over your anterior ankle joint, perhaps contributing to the impingement symptoms.

As such, it might be worth visiting a Sports Medicine Centre or a Sports Podiatrist who provides a running gait analysis and running re-training.

This aims to look at ways to alleviate lower limb symptoms through alterations to your gait, loading patterns, footwear etc. Perhaps consider this before going along for further interventions?

BW and kind regards

Photo of Dr Alan Cheung
Dr Alan Cheung

Orthopaedic Surgeon

Anterior Ankle Impingement is a condition where a patient has pain at the front of the ankle, due to compression of the bony or soft tissue structures during activities which involve deep ankle bending (maximal dorsiflexion).

Simple measures to reduce pain include avoiding walking or running on uneven ground, nonsteroidal anti-inflammatory drugs if tolerated, and ankle bracing.

I would strongly recommend that you see a good physiotherapist. They may use a physical therapy program that includes reducing inflammation, deep soft-tissue work on the gastrocnemius and soleus muscles, stretching of the Achilles tendon, work on improving proprioception and balance, strengthening of the peroneal tendon, and taping.

Although you may not have any bony cause for the pain in your ankle, soft tissue structures such as synovium, scar tissue or fibrocartilage may be being trapped causing pain. This problem may be addressed through keyhole surgery, if non-surgical management fails.

With regards to TCM, I am afraid that I know very little about this topic, as I grew up in England and am a Western trained doctor.

The good news is that 82% of patients with ankle impingement respond well to conservative treatment such as physiotherapy in the long term.

Sorry to hear about your unlucky situation with the army.

Anterior ankle impingement is due to inflammation and scar tissue forming in the front part of your ankle joint, limiting range of motion and causing pain, just as you’ve described. It’s attributed to repeated strain of the front portion of your ankle joint.

It sounds like your doctor has taken the right steps with an MRI given the length of pain – it’s good news that there’re no bony spurs or visible deformities.

Unfortunately, I cannot recommend TCM in this instance as there is no scientific evidence behind it for sports-related injuries.

What I’d do instead –

The treatment for anterior impingement is conservative or surgical.

Conservative treatment is basically some of what you’ve already tried: Rest, anti-inflammatory medications/steroid injections to relieve pain and swelling, as well as physiotherapy.

Physiotherapy plays a big role in conservative treatment to help you rehabilitate. This is what I’d focus my attention on if I were you.

A well-planned programme can help you to reduce pain, improve the range of motion in your ankle, and break down scar tissue. A sport medicine doctor in conjunction with a physiotherapist will be able to plan a thorough rehab programme for you.

If conservative treatment doesn’t work, your doctor may recommend minimally invasive surgery. This can be done with an ankle arthroscopy.


“What should I do?” – See a sports medicine doctor for an assessment/examination and proper rehab plan in conjunction with a physiotherapist.

“Should I go for another injection to see if the pain fully goes away?” – Likely to be a temporary fix only from what you’ve told me. Your sport doctor can advise accordingly.

“Or should I try alternative medicine like TCM?” – No. 🙂

“I wonder if those ‘tui na’ massage are of any help.” – No. 🙂


Similar Questions

How can I differentiate runner's knee from other causes of knee pain?

Thank you for expressing your concern about the knee pain you are experiencing. Needless to say, you are not alone and I see many young men in your situation at the Sports Clinic. As Dr Sean mentions there can be several causes for knee pain and “runner’s knee” is a broad term for pain at the front of your knee. Important things to consider are 1. Swelling to the knee 2. Locking symptoms 3. Instability or giving way 4. Difficulty with stairs If there are any of these symptoms, there might be something more significant going on.

Photo of Dr Dinesh Sirisena

Answered By

Dr Dinesh Sirisena

Sport Medicine

How long does a steroid injection for back pain due to degeneration of disc take to work?

Thank you for your question - certainly an interesting one. Without knowing where exactly the injection was placed it is hard to know what effect you should have experienced. Nevertheless, steroid injections typically last a few months and allow the individual to do other rehabilitation/treatments for their pain symptoms. The duration of the effects can also depend on 1. The individual 2. Activity levels 3. Previous injections From clinical experience of facet joint and nerve root injections, the effect is typically seen within within a month, but again it depends on the individual.

Photo of Dr Dinesh Sirisena

Answered By

Dr Dinesh Sirisena

Sport Medicine

Ask any health question for free

I’m not so sure about a procedure...

Ask Icon Ask a Question

Join Human

Sign up now for a free Human account to get answers from specialists in Singapore.

Sign Up

Get The Pill

Be healthier with our Bite-sized health news straight in your inbox