The Ankle Impingement Sign assesses whether ankle dorsiflexion reproduces familiar anterior ankle pain, often around the anteromedial or anterolateral joint line. Anterior ankle impingement is described as a pain syndrome related to soft tissue or bony impingement, commonly associated with chronic ankle pain, limited dorsiflexion and swelling. Diagnosis should be based on history, physical examination and imaging where needed rather than a single provocation sign.
A client reports pinching at the front of the ankle during deep squats, lunges, downhill walking, landing, running or dorsiflexion-based mobility work. They may have a history of repeated ankle sprains, swelling or stiffness after sport.
The Ankle Impingement Sign can help assess whether dorsiflexion reproduces the client’s familiar anterior ankle symptoms. The result should be interpreted with ankle ROM, swelling, previous injury history, palpation and functional dorsiflexion tasks.
Test name: Ankle Impingement Sign
Also known as: Anterior Ankle Impingement Test
Body region: Anterior ankle, talocrural joint
Purpose: Assess anterior ankle pain response to dorsiflexion
Positive finding: Familiar anterior ankle pain, pinching or blocked sensation during dorsiflexion
Negative finding: No familiar anterior ankle symptoms during the test
Best used with: Ankle dorsiflexion ROM, weight-bearing lunge test, palpation, swelling, squat/lunge assessment and imaging/referral when indicated
Key limitation: It does not identify whether symptoms are caused by bony or soft-tissue impingement
The Ankle Impingement Sign is a symptom provocation test for anterior ankle pain. The ankle is moved into dorsiflexion while the professional monitors for familiar anterior ankle pain, pinching or a blocked feeling.
It may be performed non-weight-bearing or in a functional weight-bearing position, depending on the client and setting.
The test is used when anterior ankle impingement or dorsiflexion-related ankle pain is suspected.
It may be relevant for clients with pain during squats, lunges, stairs, running, jumping, landing, football, dance, weightlifting or repeated ankle dorsiflexion loading.
The test assesses symptom response to dorsiflexion. It does not confirm impingement structure, bony spur, synovitis or soft-tissue entrapment.
Anterior ankle pain may also be influenced by talocrural stiffness, anterior joint irritation, osteophytes, swelling, tendon symptoms, cartilage injury or post-sprain changes.
This test may be useful for runners, field-sport athletes, dancers, gym clients, weightlifters and clients with anterior ankle pain during dorsiflexion-heavy tasks.
Use when the client reports anterior ankle pain or pinching during dorsiflexion and the ankle can tolerate controlled movement.
Use caution with acute trauma, suspected fracture, severe swelling, recent surgery, marked pain, instability or inability to tolerate dorsiflexion.
Treatment table or floor space
Pain scale
Measurz recording workflow
Optional goniometer or inclinometer
Optional weight-bearing lunge measurement
Choose non-weight-bearing or weight-bearing testing depending on the client’s irritability and goals.
For non-weight-bearing testing, the client may sit or lie with the ankle accessible. For weight-bearing testing, the client may move into a lunge or squat-style dorsiflexion position.
Observe the ankle and control movement as needed.
For non-weight-bearing testing, support the foot and lower leg. For weight-bearing testing, monitor knee tracking, foot position and symptom response.
Avoid forcing dorsiflexion. Keep the foot position consistent.
Move the ankle into dorsiflexion or ask the client to move into controlled dorsiflexion.
Ask the client to report pain location, pinching, blocking, stiffness, swelling sensation and whether symptoms match their usual complaint.
A positive Ankle Impingement Sign is familiar anterior ankle pain, pinching or blocked sensation during dorsiflexion.
A negative finding is no familiar anterior ankle symptoms during dorsiflexion.
Stop if pain increases sharply, the ankle feels unstable, symptoms persist or movement is not tolerated.
Record whether the test was weight-bearing or non-weight-bearing.
A positive Ankle Impingement Sign may support anterior ankle impingement reasoning when familiar anterior pain or pinching is reproduced during dorsiflexion and aligns with history, dorsiflexion restriction and functional symptoms.
A positive result does not identify the exact structure involved. Anterior ankle impingement may involve soft tissue in the anterolateral compartment or bony changes more commonly in the anteromedial compartment, but clinical testing alone cannot confirm the source.
A negative test suggests dorsiflexion did not reproduce symptoms under the tested conditions, but it does not exclude ankle impingement or other anterior ankle pathology if symptoms occur only under high load or fatigue.
High-quality 2020+ diagnostic accuracy values for the Ankle Impingement Sign alone appear limited.
Condition or presentation: suspected anterior ankle impingement syndrome
Population: clients with anterior ankle pain, limited dorsiflexion or chronic ankle symptoms
Test variation: dorsiflexion-based symptom provocation, with possible palpation or weight-bearing variations
Reference standard: not consistently established for the clinical sign alone
Sensitivity: not clearly established
Specificity: not clearly established
Positive likelihood ratio: not available
Negative likelihood ratio: not available
Key limitations: variation in test method, overlap with stiffness, osteophytes, synovitis, swelling and post-sprain symptoms
A state-of-the-art review describes anterior ankle impingement as a pain syndrome and emphasises diagnosis using history, physical examination and imaging where required rather than relying on one sign alone.
Reliability depends on test position, dorsiflexion angle, weight-bearing status, foot position, symptom criteria and whether the professional records exact symptom location.
Validity improves when the test is interpreted with measured dorsiflexion, swelling, palpation, functional movements and imaging/referral when needed.
Common errors include forcing dorsiflexion, not recording weight-bearing status, treating any stiffness as impingement, failing to measure dorsiflexion and ignoring previous ankle sprain history.
Limitations include poor structural specificity, symptom overlap and limited stand-alone diagnostic accuracy evidence.
Use the Ankle Impingement Sign to document dorsiflexion-related anterior ankle symptoms and guide mobility, loading, exercise modification or referral decisions.
Record test name, side tested, result, pain score, symptom location, weight-bearing or non-weight-bearing method, dorsiflexion angle if measured, foot position, pinching/blocking sensation, swelling, comparison side, confidence in result and reason for stopping.
Add related ankle dorsiflexion ROM, weight-bearing lunge test, squat/lunge findings, anterior joint palpation, previous sprain history and functional task notes.
Ankle Dorsiflexion Test
Weight-Bearing Lunge Test
Anterior Drawer of the Ankle
Talar Tilt Test
Single Leg Calf Raise
Squat Assessment
Balance and Proprioception Tests
Hop Tests
It assesses whether ankle dorsiflexion reproduces familiar anterior ankle pain or pinching.
A positive finding is familiar anterior ankle pain, pinching or blocking during dorsiflexion.
No. It may support suspicion, but imaging and broader assessment may be needed.
It can be performed weight-bearing or non-weight-bearing. Record the method used.
Record side, pain score, symptom location, dorsiflexion position, weight-bearing status and related ROM or functional findings.
The Ankle Impingement Sign is a dorsiflexion symptom-provocation test.
A positive result should reproduce familiar anterior ankle pain or pinching.
It does not identify the exact impinged structure.
Dorsiflexion ROM and functional testing add important context.
Measurz should capture method, symptoms, position and comparison findings.
Diniz, P., Sousa, D. A., Batista, J. P., et al. (2020). Diagnosis and treatment of anterior ankle impingement: State of the art. Journal of ISAKOS, 5, 295–303.
