Footballer's ankle is a sports disorder resulting from forced ankle plantar dorsiflexion.

Disease Overview

Footballer's ankle is a disorder of the ankle that are familiar in Europe and the United States among football players. It is also called ankle impingement syndrome, collisional exostosis, etc. Plantar dorsiflexion of the ankle joint is forced by kicking in football or jumping in basketball. It causes impingement of the ankle joint and results in this sports disorder. (Fig. 1).
* Impingement = caking

Figure 1. Osteophytes on the anterior aspect of the tibial lower end and dorsal aspect of the talus and calcaneus.

Cause and mechanism of onset

Mechanism

The anterior joint capsule is hyperextended by plantar flexion forces on the ankle joint, such as kicking in soccer. In the rear, the bones are damaged by striking on each other. On the other hand, when a person steps on a jump landing, dorsiflexion is forced with impingement on the anterior bone, and the posterior joint capsule is injured by hyperextension. Collisions between bones can damage bone and cartilage (Fig. 2), and osteophytes can form as a repair mechanism for this damage. Athletes who experienced ankle sprains several times become more ankle unstable, resulting in osteophyte formation, joint capsule synovial proliferation, and worsening of pain and other symptoms. In advanced cases, osteophytes may cause fracture, become loose in the joint, or become impinged which cause severe pain.

Figure 2. X-ray (arrow indicates an osteophyte).

Symptoms

Spontaneous pain, tenderness, pain during exercise, and palpation of osteophytes at the ankle joint during kicking or jumping, and, as it progresses, limited range of motion at the ankle joint. The presence of osteophytes on the anterior aspect of the joint may limit dorsiflexion, and osteophytes on the posterior aspect may limit plantar flexion.

Diagnosis

Diagnosis

The X-ray image in Fig. 2 is a typical image of osteophyte formation in the anterior aspect of the lower end of the tibia, the anterior aspect and neck of the talus, and the posterior aspect of the talus. When a collision is caused by varus or valgus stress of the ankle, osteophytes form on the medial and lateral malleoli and talus. Three-dimensional CT (Fig. 3) is more useful for locating and sizing osteophytes.

Figure 3. Three-dimensional CT image.

Common sports

Football and rugby with kicking exercises that place a high burden on the ankle, instrumental exercises that allow plantar dorsiflexion of the ankle to be forced with jump landing, classic ballet, basketball, and volleyball are common sports.

Treatment and rehabilitation

Treatment

In the acute phase, physical therapy, such as local rest, icing, and sometimes apply hot packs, ultrasound, and low frequency therapy are used to treat pain and swelling. Taping and braces to limit joint mobility may also be helpful. When pain is severe, hyaluronan and corticosteroid injections, as for osteoarthritis, are given (but often avoided). If symptoms do not improve with conservative treatment or if a piece of bone is loose, the osteophytes may be surgically removed. Initial rehabilitation begins with non-weight-bearing range-of-motion exercises of the ankle. Next, the patient exercises on the ankle with a light load with a tube and gradually increases the load to aerobics and pool walking.

Photo: Rehabilitation in the initial stage is followed by exercise of the ankle joint with a light load with a tube, and the load is gradually increased.