The Pinch at the Front of Your Ankle — Understanding Anterior Ankle Impingement

At The Australian Ballet, dancers used to go under the knife for ankle impingement at a rate that worried the medical team. Then Sue Mayes — the company’s Director of Artistic Health and principal physiotherapist for more than two decades — sat down with the data and rebuilt the programme. She prescribed twenty-four slow single-leg calf raises a day, removed the calf stretching equipment from the studios, and asked the dancers to shake out their calves instead of stretching them. Over the next decade, ankle surgery in the company dropped to four cases — three of whom had joined from outside. For dancers raised in the company’s own system, impingement that needed an operating theatre became a rarity.

That is one of the most useful clinical stories in ankle medicine, and it tells you almost everything about how anterior ankle impingement works.

What is happening at the front of your ankle

Anterior ankle impingement is what it sounds like. When you bend your ankle upward — the movement clinicians call dorsiflexion — the front of your shin bone and the top of the talus (the bone that sits under your shin) meet earlier than they should. They pinch.

Sometimes the pinch is bony. Repeated end-range loading over years lays down small bone spurs at the joint margin. The spurs run out of room first. This is the classical “footballer’s ankle” — described in soccer players for so long that the name stuck.

Sometimes the pinch is soft tissue. The lining of the joint thickens, scar tissue from old sprains builds up in the gutter at the side of the talus, or a small accessory ligament becomes hypertrophic. The tissue runs out of room first.

Both versions feel similar. A sharp, focal pain at the front of the ankle when you load it deeply — squats with the knee well over the toes, deep lunges, landing from a jump, the bottom of a plié, the moment of impact when you kick a ball. The pain is local. It is not a dull ache. It is a pinch.

Why it happens — and why athletes get it

The condition has a nickname for a reason. Footballer’s ankle. Across the codes — soccer, AFL, NRL, rugby union — the players who present with the pinch tend to be the ones who kick, jump, decelerate, and pivot the most.

Niek van Dijk and Johannes Tol — the Dutch sports medicine group whose work has shaped this field for two decades — filmed fifteen elite soccer players kicking a ball 150 times. They showed that in nearly four out of ten kicks, the ankle was forced past the range it could reach when stationary. The contact zone of the ball was the anteromedial foot in 89 percent. Year after year of this — the kicking impact, the cutting and turning, the deceleration — and the body lays down extra bone exactly where the impact lands.

Quade Cooper makes the point cleanly. The Wallabies fly-half, a goal-kicker through every level of his career, finally had a bone spur shaved off the back of his left heel in August 2024 — a long-standing issue he had played through for years. The mechanism is the same family of problem. End-range ankle stress, repeated season after season, eventually leaves a bony deposit the surgeon has to remove.

Luke Keary tells a parallel story in the NRL. The Roosters playmaker had a bone spur removed from his ankle late in 2021 to free up an old issue that traced back to a 2019 ankle injury. Cleaning out the joint was what allowed him to return to a normal pre-season.

In the AFL, the same loading pattern is everywhere — ruckmen who land thousands of jumps over a career, midfielders who decelerate and pivot under pressure, key forwards who kick hundreds of goals from set positions. The condition is so common across these codes that “footballer’s ankle” is the working name for it in clinic.

Add the other sports that load the ankle deeply — basketball, gymnastics, ballet — and the pattern is clear. They all push the joint to its end of range, repeatedly, under load.

The reason ballet is such a good window onto this condition is that it produces both the anterior pinch (from plié work) and the posterior pinch (from pointe work) in the same dancers. Sue Mayes’s group has published a four-year injury surveillance of an Australian professional ballet company showing ankle synovitis and impingement among the most frequent pathologies the medical team manages.

What not to do

The single most common mistake is to push through the pinch.

The pinch is the joint telling you that two bones are meeting too early. Forcing dorsiflexion under load — pushing deeper into the squat, deeper into the lunge with the knee over the toes, deeper into the plié, kicking harder through pain — does not stretch the joint open. Over time, it lays down more bone. The next year you have a slightly bigger spur and slightly less range. The year after that, less again. By the time a player or a dancer presents for surgery, the bony block has often been ten years in the making.

Aggressive ankle “mobility” routines that try to force the dorsiflexion block by leaning into a wall with all your bodyweight fall into this category. So does a calf stretching routine that uses the dorsiflexion end-range as the lever. Length is not the problem. The bones are.

What to do

The conservative pathway has a small number of components that matter.

Avoid deep dorsiflexion under load. This is a temporary modification — not a permanent restriction. Cut depth on squats and lunges. Avoid the bottom of the plié for a few weeks. Modify the run pattern so deceleration is softer. The aim is to reduce the daily count of pinch events while the joint settles. A good physio will tailor this to your sport.

See a physiotherapist who can mobilise the joint in the right direction. The talus can be glided backward by hand during active dorsiflexion — done well, this can buy real movement without driving impingement. Done badly, it makes things worse. This is technique-dependent and should not be self-applied.

Build calf endurance the right way. This is where the Sue Mayes work matters most. The calf is the muscle group that controls how your ankle decelerates and how it positions itself at the top of plantarflexion. Building calf endurance — slow, controlled single-leg heel raises, high repetition, working into the soleus as well as the gastrocnemius — quietly changes the mechanics around the joint without ever loading the pinch zone. In Mayes’s interview on the Physical Performance Show podcast in 2025, she described how this single change in programming reshaped injury rates at The Australian Ballet over a decade.

Manage your load week to week. The bony version of impingement is essentially a load-tolerance problem written in bone. Sudden spikes in dorsiflexion-loading volume — preseason at the football club, intensive blocks in the ballet studio, a new training programme that adds depth to your squats — are the moments the joint flares. Spread the load, train the calf, and respect the warning signs.

The soleus and calf angle, in plain language

Most calf training is focused on the bigger gastrocnemius — the muscle you can see. The soleus sits underneath it and does most of the work during walking, slow running, and the standing balance that fills your day. Its activation during late stance — as your foot pushes off — shapes where your ankle ends up at the top of plantarflexion and how cleanly it returns to dorsiflexion for the next step.

When the soleus is strong and well-coordinated, push-off is efficient and the joint settles back into a tidy position. When it is weak or fatigued, the rest of the calf system compensates by working harder at end-range, which subtly changes where the talus sits at peak load. Over many thousands of steps a week, that subtle change adds up.

This is part of why a calf programme reduces impingement events without ever loading the painful end-range. You are not stretching the joint. You are changing the mechanics around it.

When conservative wins, and when surgery is the answer

Honest framing. The soft tissue version of anterior ankle impingement — where the imaging shows thickened tissue but no significant bone spur — responds well to conservative management most of the time. A structured eight to sixteen week programme of load modification, joint mobilisation, and calf-endurance work resolves symptoms in the majority of cases.

The bony version with a small spur — under about 5 mm — and a healthy joint can often be managed conservatively for years, especially with attention to calf programming and dorsiflexion load.

The bony version with a larger spur, joint space narrowing, or a hard mechanical block on examination is the version where arthroscopic surgery enters the picture. Modern arthroscopic debridement — the surgeon goes into the joint through small incisions and shaves the spur — has a success rate above 80 percent in good candidates and return to sport at six to twelve weeks. Outcomes are best when there is no joint space narrowing. Outcomes are good but less reliable when there is.

When to see a sports medicine doctor

A sharp pinch on every single deep dorsiflexion that has not changed after a few weeks of modified loading and physio is worth getting imaged.

Clicking, catching, or any sense of the ankle locking momentarily is worth a doctor’s opinion. This can point to an osteochondral lesion of the talar dome — a small area of damaged cartilage on the talus that mimics impingement and needs different management.

Pain that is worsening rather than plateauing despite sensible load modification is the third warning sign.

A note on the Sleeve

You cannot fix a bone spur without surgery. But you can stop loading it.

That is the honest place to start a conversation about the Orthopaedic Sleeve. Anterior ankle impingement is a repetitive-event problem — the pinch happens, and then happens again, and then happens a thousand more times that week. Take enough of those events out of the day and the joint gets a chance to settle. Put them back in and the cycle restarts.

The Sleeve was designed as a daily-wear tool that subtly reshapes the mechanics driving the impingement. The relevant finding from the University of Queensland Final Report (June 2025) is a measured reduction in peak plantarflexion angle of approximately two degrees during walking. That sounds small until you do the arithmetic. Every step you take with the Sleeve on lands slightly outside the habitual end-range position. Across a normal day of walking — several thousand steps — that adds up to thousands of footfalls that no longer drive the joint into the pinch zone.

That is the mechanism. Not magic. Not a cure. A subtle, repeatable shift in where the ankle ends up at the top of push-off, applied across every step of your day.

The same UQ work also showed an effect on soleus muscle activation — around a 32 percent group-average change in standing balance, with individual late-stance walking maxima reaching higher numbers across the major calf muscles. The two effects pull in the same direction. The Sleeve changes the geometry of the joint by a couple of degrees while also nudging the calf system toward the kind of work that quietly protects the front of the ankle.

The honest framing matters. The Sleeve is not a treatment for an established bony spur that needs the surgeon. The Quade Cooper presentation, after years of accumulated change, is the surgical end of the spectrum. What the Sleeve does is interrupt the loading pattern that builds those spurs in the first place — and reduce the daily dose of end-range impingement for the soft tissue presentation and the early-bony presentation while your calf programme is doing its slower work.

The Australian Ballet story is the one to keep in mind. The dancers who built the calf programme into their daily work stopped needing surgery. The pinch at the front of the ankle is rarely just an ankle problem. It is a load and mechanics problem the calf can quietly fix, given time — and the Sleeve is the tool designed to nudge those mechanics in the same direction with every step you take.

References and Australian resources

1. Mayes S, et al. Musculoskeletal injury in an Australian professional ballet company, 2018–2021. J Dance Med Sci. 2023.
2. Mayes S. “Expert Edition: Managing Foot & Ankle Injuries.” The Physical Performance Show podcast with Brad Beer (POGO Physio), Episode 367, June 2025. https://www.pogophysio.com.au/blog/the-physical-performance-show-expert-edition-dr-sue-mayes/
3. Tol JL, Slim E, van Soest AJ, van Dijk CN. The relationship of the kicking action in soccer and anterior ankle impingement syndrome. Am J Sports Med. 2002;30(1):45–50.
4. Tol JL, Verheyen CPPM, van Dijk CN. Arthroscopic treatment of anterior impingement in the ankle: long-term outcomes. J Bone Joint Surg Br. 2001;83(1):9–13.
5. Pickering M. “Quade Cooper undergoes minor surgery.” RugbyJP, 8 August 2024. https://www.rugbyjp.com/post/quade-cooper-undergoes-minor-surgery
6. “Roosters star Luke Keary in doubt for round one.” ESPN, 2022. https://www.espn.com/espn/print?id=33324765
7. University of Queensland. Orthopaedic Sleeve Final Report — kinematic and EMG analysis. June 2025.