Haglund’s SyndromeNovember 18, 2019
The 21st National Congress of the Indonesian Orthopaedic Association (IOA) – Combined Meeting 39th ASEAN Orthopaedic Association Annual Congress, 20-23rd of November 2019, Jakarta, IndonesiaNovember 23, 2019
Ankle bone spurs, aka “Footballer’s ankles.”
Ankle bone spurs is a condition that occurs when an extra bone grows in front of the ankle joint. It usually develops just in front of the ankle joint at the point where the leg bone ( the tibia ) meets the ankle bone ( the talus ). This condition is also known as footballer’s ankle, athlete’s ankle, or medically as anterior ankle ‘bony’ impingement syndrome.
The bone spurs can either occur from the tibia, the talus or both. When the foot is moved upwards, the bone spurs knock on each other, resulting in severe pain and inflammation over the front of the ankle. There is a sensation of pinching or impingement of the tendons, ligaments or the capsule.
Causes of ankle bone spurs
One of the commonest causes of ankle bone spurs is osteoarthritis, a common type of ‘wear & tear “ arthritis. This condition can cause the cartilage between bones to worsen with time. The body develops extra growth of bones to compensate for missing cartilage, minimize motion in the ankle thereby reducing any pain from the ankle.
Aside from osteoarthritis, other factors can cause ankle bone spurs. Another common reason is ankle instability from repeated ankle sprains or repeated exercises that involve ankle flexion & extension.
Bone spurs can sometimes occur after deformity in the ankle, for example, after fractures or severe ligament injuries that have healed in an abnormal position.
Bone spurs are often common in the foot and ankle, but they can develop in other parts of the body such as the hips, spine, shoulder, and knees.
Symptoms of ankle bone spurs
The symptoms of ankle bone spurs vary and differ from person-to-person. The following are the signs and symptoms of ankle bone spurs:
- Severe pain over the front of the ankle joint: This is a common symptom of ankle bone spurs and it typically intensifies when the foot is moved upwards towards the shin in dorsiflexion.
- Tenderness over the front of the ankle, worse with tight shoes
- Clicking sensation when moving the ankle
- A decrease in the overall range of motion of the ankle
- Repeated ankle sprains, tendons and cartilage tear
- Redness, inflammation or swelling of the ankle after activity
Risks of developing ankle bone spurs
Many factors can increase the risk of developing a bone spur in the ankle. The factors include:
- Osteoarthritis: Anyone with this condition has a high risk of developing ankle bone spurs. The cartilage deterioration is typically associated with the development of bone spurs.
- Physical activity: Repetitive flexion and extension moments of your ankle joint stretches and relaxes the soft tissues in front of the ankle. Multiple cycles of this may predispose to eventual formation of bone spurs.
- Injury: This risk is predominant in athletes who participate in contact sports like football, basketball, rugby, and dancing. Ankle bone spurs can form after an injury, for example, a severe sprain or a fracture.
- Flat feet: When you have a low arch or nonexistent arch in the feet, this condition can cause your entire feet to touch the ground when standing. This action places extra strain on the joints of your ankle and causes different problems like blisters, corns and bone spurs.
- Age: As you get older, you tend to have a higher risk of developing ankle bone spurs. This is because cartilage breaks down as age increases, and this step by step wear and tear causes the body to create extra bone to minimize movement that is causing the pain.
- Obesity: Excess weight puts enormous pressure on your feet and other bones of your body. This condition can cause your cartilage to break down more quickly, eventually leading to a bone spur.
The diagnosis of ankle bone spurs is usually made with an X-ray. Other imaging tests like the MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) scan may be used to confirm the severity of the diagnosis and ensure there are no other pain-causing problems in the ankle joint. (such as cartilage defects or ligament tears ).
The primary aim of the treatment of ankle bone spurs is to decrease inflammation at the area of the impingement. To achieve this, the following treatments should be adopted:
- Choice of footwear: Wearing a new set of shoes can relieve the symptoms of ankle bone spur. Choose footwear that your legs fit moderately in, that is, shoes that are not too tight or too loose, and don’t pinch your toes. Perhaps you have a low arch, add extra padding / orthoses to your footwear to relieve pressure.
- Ice and heat therapy: To relieve pain associated with ankle bone spur, ice therapy is usually useful. Icing can help to ease inflammation, while heat can help to improve pain and stiffness symptoms. Apply a cold pack or heating pad on your foot for about 10 to 15 minutes at different intervals during the day.
- Weight loss: Losing excess weight helps to reduce pressure on the bones of the feet and may ease pain associated with ankle bone spurs.
- Pain killers: Non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen sodium, and acetaminophen can help to relieve pain and inflammation.
- Ankle bracing: This is a temporary solution to help prevent recurrent ankle sprains. Physical therapy can help mobilize the joint further and reduce inflammation with ultrasound therapy.
- Cortisone injection: This kind of injection helps to stop inflammation and swelling in the joints of the ankle. After taking the injection, pain, swelling, and stiffness will likely improve.
- Surgery: If the prescribed treatments seem to be unsuccessful or if pain persists, then surgery is the last resort. An orthopedic surgeon can perform ankle arthroscopy ( ankle key-hole procedure ) surgery to remove the bone spurs that cause impingement. After the surgery, you will typically start ranging the ankle from Day 1, followed by aggressive physical therapy to improve range of motion. The doctor can give you clearance to return to sports after 4 – 6 weeks.
“For a more expert opinion, please consult Dr. Gowreeson.”