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DXD Admin from Singapore asked a question

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

Hello Doctor, I have been diagnosed with anterior ankle impingement on my right foot. It was caused by over running in the army. The pain has lasted almost a year now and I finally decided to get it check. From the MRI scan, there are no bony spurs or visible deformities. It is not bothering me too much on my daily activities but still, it does cause some discomfort when I run/do sports.

For past treatments, I had a cortisone steroid injection 2 months back. The pain becomes much more bearable, albeit still present. I even stopped running for 2 months to let it heal but the healing has stagnated. What should I do? Should I go for another injection to see if the pain fully goes away? Or should I try alternative medicine like TCM? I wonder if those ‘tui na’ massage are of any help. Please offer me some scientific/non-scientific advice. 🙂

DOCTOR’S ANSWER (3)
Dr Dinesh Sirisena
Sport Medicine
Singapore
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Dr Dinesh Sirisena
Sport Medicine
Singapore
Answered on Fri Jan 26 2018 08:10:12 GMT+0000 (UTC)

Dear Sir Anchor-Man,

Agree with Dr Ethan, great name! Do you work in the media from that name? 🙂

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

0 472 views 0 Doctors agree Fri Jan 26 2018 08:10:12 GMT+0000 (UTC)
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Dr Alan Cheung
Orthopaedic Surgeon
Sport Medicine
Singapore
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Dr Alan Cheung
Orthopaedic Surgeon
Sport Medicine
Singapore
Answered on Fri Jan 26 2018 08:11:22 GMT+0000 (UTC)

Hi there,

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.

0 472 views 1 Doctors agree Fri Jan 26 2018 08:11:22 GMT+0000 (UTC)
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Dr Ethan
Singapore
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Dr Ethan
Singapore
Answered on Fri Jan 26 2018 08:12:00 GMT+0000 (UTC)

Hello Sir Anchor-man – Love your name, great nick indeed!

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.

TLDR:

“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. 🙂

Cheers

0 472 views 0 Doctors agree Fri Jan 26 2018 08:12:00 GMT+0000 (UTC)
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