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Physiotherapists And Doctors Services - Forward Ankle Pain

  Ankle ‘Anterior Impingement’ Pain – Pain across front of ankle resulting from landing “short”

Presentation
- Pain across front of ankle joint – tenderness/pain on jumping/running/landing particularly if landings “short” (body weight forward over foot with heel in contact with floor). Landing “short” causes compression (‘squashing’) of talus bone (weight bearing bone of ankle) and bottom of tibia (shin) and soft tissue (ligaments/capsule) in between bones – as joint comes together under high load.
Contributing factors
- Fatigue in training (failure to generate enough force to complete aerial skills)
- Tight ankle joints and calf muscles
- Previous injury to same area (repeated injury across front of ankle can cause build up of scar which in turn is more easily compromised and limits ankle range of motion)
Key management points
- Reduce overall loading until no impairment in function
- Improve ankle flexibility (pointing of toes to stretch any scar build up, ankle stretches on incline etc to improve range)
- Seek physio advice for confirmation of diagnosis, identification of possible contributing factors + ankle mobilisations (improve overall ankle joint ranges),  taping techniques as necessary
- If any suspicion of ankle joint fracture, limited ability to weight bear, repeated swelling episodes, failure to improve → should be referred to Sports Physician for further investigation and management advice
Management strategy
- Reduce overall volume of aggravating factors – start with activities outside of gym (minimise loading school, other sports, home etc). If symptoms persist begin to reduce aggravating gym skills/apparatus – e.g. floor and vault numbers until pain manageable.
- Keep diary of activity levels → if symptoms increasing, reduce overall activity levels until pain begins to subside
- Reduce swelling and scar build up across front of ankle
- Improve ankle flexibility (pointing of toes to stretch any scar build up, ankle stretches on incline etc to improve range)
- Heel cups/padding/lifts all times in and out of gym when recovering to ensure no further compression of injured tissue across front of ankle.
- Tape ankles as necessary for training to improve ankle stability.
- Calf flexibility
- Ice baths post training if symptomatic
- Continue lower limb conditioning calf/quads/gluts (low impact) to assist muscular ability to absorb loads when landing etc.    
Flexibility
- General lower limb flexibility
- Calf stretches
- Ankle stretches on incline board
Strength/conditioning
- Trunk endurance exercise all planes of support
- Hip/pelvic/lower limb control exercises in position of support
- Calf raises
CV fitness
- E.g. exercise bike intervals (long/low intensity) to maintain general aerobic fitness – reduce running volume
Physiotherapy
- Ankle mobilisations, soft tissue mobilisation of calf, and progression of conditioning exercises, review of suitable training progressions and timelines
Return to sport
- Progression and increased loading depending on pain. If pain levels reduced to level allowing normal function, can resume activity. If pain increases causing modification of technique, then athlete to reduce overall volume of loading of heel.
Key management points
- Reduce overall loading until no impairment in function
- Reduce swelling and scar tissue
- Seek physio advice for confirmation of diagnosis, identification of possible contributing factors, management outline   
- Pain and disability significant and/or not improving, should seek advice of Sports Physician for possible further investigations and management advice.

 
 
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