Treatment for Lateral Ankle Impingement
Functional treatment with exercise therapy and a semi-rigid ankle brace for 4-6 weeks is the recommended first-line treatment for lateral ankle impingement, followed by arthroscopic debridement if conservative measures fail. 1
Initial Conservative Management
Functional Support
- Use a semi-rigid ankle brace rather than elastic bandages or tape for 4-6 weeks 2, 1
- Brace provides better functional outcomes and faster return to activities than other support types 2
- Protected weight-bearing with crutches as tolerated is recommended initially 1
Pain Management
- NSAIDs (oral or topical) for short-term pain relief 1
- Paracetamol (acetaminophen) is equally effective with fewer side effects 1
- Avoid complete immobilization as it delays recovery 2, 1
- Note: The RICE protocol (Rest, Ice, Compression, Elevation) alone is not recommended as it has not been shown to be effective 1
Exercise Therapy
- Begin supervised exercise therapy within 48-72 hours post-injury 1
- Exercise program should include:
- Range of motion exercises
- Proprioception training
- Strength training
- Neuromuscular control exercises 1
- Continue exercise program for 4-6 weeks 2, 1
- Exercise therapy reduces the risk of recurrent injury (RR 0.37; 95% CI 0.18 to 0.74) 2
Manual Mobilization
- Manual joint mobilization in combination with exercise therapy enhances treatment efficacy 2
- Provides short-term increase in ankle dorsiflexion range of motion and decreases pain 2
Treatment for Refractory Cases
When conservative management fails after 6 weeks, consider:
Arthroscopic Debridement
- Arthroscopic debridement is successful in relieving pain and disability in high percentages of patients with lateral ankle impingement 3
- Most patients are able to return to previous levels of work and sports after arthroscopic intervention 3
- Targets hypertrophic soft tissue in the lateral gutter that becomes trapped between the talus and lateral malleolus 3
Surgical Considerations
- Surgery should only be considered after failure of conservative treatment 2, 4
- May be considered earlier in professional athletes requiring rapid recovery 1
- Functional treatment is preferred over surgical therapy in most cases 2
- Early functional rehabilitation after surgery leads to earlier return to work and sports 5
Return to Activity Criteria
- Pain-free walking
- Full range of motion
- Restored strength
- Ability to perform sport-specific movements 1
- Continued use of support (orthosis or bandage) is recommended, especially in individuals with recurrent sprains 1
Common Pitfalls and Caveats
- If pain persists beyond 6 weeks, consider other causes such as osteochondral lesions or chronic instability 1
- Lateral ankle impingement often results from inadequate rehabilitation after an initial ankle sprain 3
- Accurate diagnosis is crucial - exclude other causes of chronic ankle pain before treatment 3
- Ankle arthroscopy is important for treating associated intraarticular lesions, but all-arthroscopic ligament repair has a high complication rate 6
- Patients with underlying foot deformity may benefit from deformity correction in addition to standard treatment 6
The evidence strongly supports a progressive approach starting with functional treatment including bracing and exercise therapy, with arthroscopic intervention reserved for cases that fail to respond to conservative measures.