Why Does It Hurt When I Point My Foot Upwards?
Feeling pain at the front of your ankle when you try to point your toes and foot upwards?
This is a classic indicator of an anterior ankle impingement. Simply speaking, this occurs when the resulting space between your bones at the ankle as you point your foot up is very small to the point that it pinches or irritates tissues, tendons, vessels or other structures.
Medically speaking, an ‘impingement’ refers to abnormal contact between parts of the body, in this case the ‘anterior ankle’, meaning the front of the ankle. This is an extremely common injury in Australia and one of the most common musculoskeletal injuries in the lower leg and foot.
What causes an anterior ankle impingement?
An anterior ankle impingement is caused by either trauma/injury (like jumping down from a high surface or when kicking a ball or hard) or repetitive compressive forces on the structures of the ankle (like repetitively compressing the ankle as you do a big uphill run). This compression occurs on movements that point the foot upwards (dorsiflexion). Some people are more prone to developing an ankle impingement from having either irregularities in the shape of their bones at the front of the ankle, a bony protrusion (called an osteophyte) in the area, or improper healing following an injury such as an ankle sprain. The resulting pinching and compression irritate the joint capsule and tissues and results in swelling and pain.
Activities and sports that regularly point the foot upwards are more likely to lead to anterior ankle impingement, as well as one-off injuries. Contributing factors may include:
- Abnormal foot biomechanics
- Ankle sprains
- Running uphill
- Soccer and other sports that involve regularly kicking a ball
- Stiffness at the ankle joint
- Squatting and jumping activities
- Tripping/falling with the foot still flat on the ground
- Poor technique in running or other sports
What are the symptoms?
Symptoms of an ankle impingement can include:
- Pain and tenderness at the front of the ankle
- Stiffness or weakness at the ankle joint
- Pain is exacerbated by pointing the toes upwards
- Reduced flexibility and movement at the ankle joint
How is an ankle impingement treated?
The first step is to help manage your painful and uncomfortable symptoms that may have occurred after a sharp impingement. This is done using the PRICE principles (protection, rest, ice, compression, elevation). Make sure you avoid all activities that require you to point your toes. Surprisingly, wearing shoes with a slight heel (make sure they’re stable and don’t go overboard!) is actually helpful at this time as it encourages you to walk with your toes pointed downwards, opening up the space at the front of the ankle and reducing the risk of further impingement to add to your pain.
The next step is to assess your ankle and the severity of the damage so that an effective management plan can be created that focuses on helping repair the damaged structures and preventing this from recurring in the future. In most cases, conservative (non-surgical) care is sufficient. This may include:
- Manual therapy to loosen up the structures of the ankle
- Custom foot orthotics to control the movement of the foot, lift the heel to create a larger space at the anterior ankle and correct any biomechanical abnormalities present
- Footwear assessment to ensure that footwear is helping and not hindering recovery
- Stretching tight muscles that may have contributed to the injury
- Strengthening weakened muscles as a result of the injury or that may have contributed to the injury
- Gait retraining to work on proper technique and reduce the risk of future injury
If the condition persists after conservative treatment, or the injury is severe, surgery may be indicated to correct the cause of the impingement - typically a bony spur in the front of the ankle, which will be removed. We can refer you for a surgical consultation if required. Surgery is typically minor keyhole style with good recovery rates for patients who seek help at the first signs of trouble
How long will it take to recover?
Treatment and recovery times truly depend on how early you recognise the problem and seek treatment. The earlier this occurs, the less damage will be done to the tissue in your foot and the faster your recovery will be. For conservative treatment, the recovery period is typically 2 - 4 weeks. For patients that require surgery, recovery typically takes 6 - 8 weeks.
We want to get you back to doing what you love without pain - so if you’re worried about your legs or you’ve suffered an injury - whether it’s painful or not - we’d love to help. We’ve been helping our community in Toowoomba & Darling Downs for over 20 years. To book an appointment, call us on (07) 4638 3022 or book your appointment online here.
- Vaseenon T, Amendola A. Update on anterior ankle impingement. Current Reviews in Musculoskeletal Medicine. 2012 Jun;5(2):145-50