What are footballer's ankle, kissing osteophytes, andpeek-a-boo heels? And what do they have in common? Athletes involved in running and jumping sports can develop a condition called footballer's ankle or medial ankle impingement. Medial refers to the side of the ankle closest to the other leg.

Typical symptoms include ankle pain, a clicking sensation when moving the ankle, and loss of ankle motion. These symptoms are the result of "impingement". The term "impingement" always tells us something is getting pinched.

In cases of medial ankle impingement, there are bone spurs (osteophytes) opposite one another (hence, the term "kissing osteophytes"). With certain movements of the ankle (e.g., dorsiflexion or moving the ankle toward the face), the opposing bumps of bone butt up against each other, stopping motion. Sometimes the deltoid ligament gets caught between the two bone spurs, another example of impingement.

Anyone with a foot deformity called cavus (high arch) is at risk for medial ankle impingement. And that's where the term "Peek-a-boo" heels comes in. The high arch is accompanied by a shift in the foot. When looking at someone's cavus feet from the front (the person is standing), the heels are visible on the medial (inside) edge of the foot. Normally, the inner edge of the heel is not visible from the front.

Football players aren't the only ones who can develop this condition. Other athletes engaged in sports like basketball, soccer, distance running, and gymnastics have developed medial ankle impingement. Most of the affected individuals have a subtle (mild) cavus foot malalignment. Changes in foot position after nonsporting injuries such as ankle and foot fractures can also lead to medial ankle impingement.

What can be done about this problem? First, the cavus foot can be treated with a special shoe insert called an orthotic. This firm piece of plastic is molded in such a way to support the arch in a slightly lower position than normal for that person. Dropping the arch down this way helps realign the ankle and foot and may help resolve the impingement problem.

For patients who have an unstable ankle, bracing may be necessary. And for those who don't get better with orthotics or bracing, surgery to remove the bone spurs and any loose pieces of bone or cartilge may be needed.

The surgeon may tighten up loose ankle ligaments at the same time. In all cases, a reduction in exercise helps decrease the symptoms. And the reverse is also true: increased exercise makes things worse.

Does the athlete have to retire forever after surgery? Fortunately, no -- results are usually very good and even young athletes can get back into action fairly quickly. They will probably always have to use at least the shoe orthotic if there is a cavus foot present.

But there is one word of caution: the bone spurs can come back with intense activity and repetitive ankle motions. Athletes with the cavus foot deformity are also at increased risk for stress fractures of the navicular bone in the foot and the long bone of the fifth toe.

Can this problem (medial ankle impingement) be prevented? A good question but not one that has been explored yet. Since not all athletes with a subtle cavus foot develop bone spurs or fractures leading to impingement, there may be other factors at work. Finding out what those risk factors may be will help guide surgeons in finding ways to prevent medial ankle impingement in athletes.

Reference: Arthur Manoli II, MD. Medial Impingement of the Ankle in Athletes. In Sports Health. November/December 2010. Vol. 2. No. 6. Pp. 495-502.