Impingement Symptoms & Causes

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Background

If you’re experiencing discomfort in a joint of your lower limbs, such as the ankle, or between two bones, particularly when performing movements like pointing your foot up or down, impingement could be a contributing factor.

In podiatry, impingement refers to the restriction or compression of a structure or tissue in the lower limbs. This increased pressure on the affected area can lead to pain or discomfort, especially with certain movements.

pain in plantar foot indicated by redness highlighted on the right foot, possibly caused by impingement

Table of Contents

Causes For An Impingement

Using the ankle as an example, consider a situation where muscle, tissue, an extra bone, or a nerve is located at the front of the joint. When you lift your toes towards the sky, the space at the front of the ankle decreases. If this movement is gentle and natural, it’s unlikely to cause any discomfort.
 
However, repetitive or excessive positioning of the ankle in this way—such as during sports that involve frequent pushing off the ground—can irritate or injure structures at the front of the ankle, leading to symptoms that require proper care for healing. Sometimes, a single sudden movement, like tripping forward while your foot is planted during running, can trigger these symptoms. Additionally, impingement can arise after a fracture or injury when swelling compresses nearby tissues, contributing to pain and dysfunction.

Symptoms Of An Impingement

The symptoms you experience will largely depend on the structure that has been affected. If a muscle or tendon is involved, you may notice pain, tenderness, and swelling. As the swelling progresses, movement in the area can become restricted and painful, which may make walking difficult, depending on the location of the injury.

If a nerve is compressed, you’re more likely to experience nerve-related symptoms such as burning, numbness, tingling, pins and needles, or pain and tenderness. In some cases, multiple structures may be affected simultaneously, leading to a combination of these symptoms.

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Common Impingements In The Lower Limbs

  • Anterior ankle impingement: Involves stress on the structures at the front of the ankle, such as the articular cartilage.
  • Posterior ankle impingement (Os Trigonum Syndrome): A condition affecting the back of the ankle, often involving an extra bone (Os Trigonum).
  • Tarsal tunnel syndrome: Compression of the tibial nerve within the tarsal tunnel, causing nerve-related symptoms.
  • Medial ankle impingement: Involves structures on the inner side of the ankle being compressed or irritated.
  • Lateral ankle impingement: Compression of tissues on the outer side of the ankle.
  • Peroneal nerve impingement: Occurs at the back of the knee, often leading to nerve-related symptoms.
  • Interdigital nerve impingement: Compression between the metatarsal heads, which can progress to Morton’s neuroma with swelling and irritation.
  • Accessory bone impingement: Compression of extra bones around the foot.
  • Impingement of unexpected structures: Includes soft tissue abnormalities like ganglion cysts.

Lower Limb Impingements Treatment

Because impingements can present with symptoms similar to tendinopathies, arthritis, fractures, and other conditions, obtaining an accurate diagnosis from your podiatrist is the crucial first step for effective treatment and management.

Once diagnosed, the primary focus is on alleviating pain and reducing compression or pressure on the affected structures, especially when swelling is involved. This may include custom foot orthotics, braces, splints, footwear adjustments, padding, strapping, or other supportive measures. Swelling can be managed with strategies such as ice application, elevation, compression, rest, off-loading, and non-steroidal anti-inflammatory drugs (NSAIDs). Since symptoms and causes can vary significantly, it’s essential to have a tailored treatment plan developed by your podiatrist to achieve optimal results efficiently.

A long-term approach is also necessary to prevent the recurrence of pain and injury. If your impingement is caused by repetitive activities, like sports, continuing without adjustments may lead to the problem returning. At Priority Podiatry Clinic, we aim to help you remain pain-free and enjoy your favourite activities without discomfort. Your podiatrist will discuss personalised long-term strategies based on your diagnosis, symptoms, lifestyle, and medical history to help you maintain lasting relief.

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