Anterior Ankle Pain (Front)

Anterior ankle pain

Pain at the front of the ankle is known as anterior ankle pain. It can be sudden onset (acute) or develop gradually through overuse. Here we explain the causes of pain at the front of the ankle.


Tibialis anterior tendonitis/tendinopathy

Tibialist anterior tendonitis

The tibialis anterior muscle is the large muscle that runs down the outside of the shin. it is a powerful dorsifexor of the ankle (lifts the foot up).

  • Inflammation of the tendon sheath can cause pain at the front of the ankle, particularly when bending the foot and toes up.
  • Symptoms also include pain when bending the foot and toes up.
  • You may also have swelling and redness over the front of the ankle.
  • If you push your fingers into the tendon you can sometimes feel a creaking when you move the foot up and down.

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Ankle Impingement

Ankle impingement is when a bony growth at either the front or back of the ankle bone restricts normal ankle range of motion. A bony spur at the front causes anterior ankle pain.

  • Impingement means tissues have become trapped between bones.
  • It occurs where the ankle bone meets the shin bone, and often follows a sprain that hasn’t fully healed.
  • Ankle impingement can affect the front of the ankle or the back.

High Ankle Sprain

High ankle sprain

A high ankle sprain is a tear of the anterior tibiofibular ligament at the top of the ankle. A high ankle sprain is likely to be more severe and difficult to treat.

  • Symptoms of a high ankle sprain include pain on tibiofibular ligament as well as swelling or bruising.
  • The patient will have difficulty walking. Severe injuries can also cause damage to the membrane connecting the Tibia and Fibula (called the syndesmosis).
  • A high ankle sprain sometimes occurs with a fracture of one of the lower leg bones.

Diagnosing anterior ankle pain

Your doctor or therapist will do a full assessment to diagnose the cause of your pain. In order to do this they will take a full case history to understand how your injury occured. This will give an initial idea of what your injury might be. Next they will see how your ankle moves and whether any specific movements trigger pain.

  • Active movements – these are where you move your ankle yourself.
  • Passive movements – this is where your therapist moves your ankle while you completely relax.
  • Resisted movements – these are where you try to move your ankle whilst your therapist applies resistance.

Active and passive movements give an idea of range of motion and whether it is restricted in any way. Pain on active or passive movements may indicated impingement or ligament injury.

Resisted movements applied stress to muscles and tendons. Therefore, any symptoms reproduced during resisted movements may indicated injury to muscle or tendon. You can understand why it is important to have a good understanding of ankle anatomy to successfully diagnose anterior ankle pain.

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