Ankle Impingement (Posterior) Causes, Symptoms & Treatment

Ankle impingement (posterior) is a condition that generates pain in the back of the ankle, especially during activities that require pointing your toes down. This condition happens when soft or bony tissue between the shin bone (tibia) and the heel bone (calcaneus) gets compressed. This causes inflammation and pain. Some people have a small bone (called the os trigonum) or a bony protuberance (Stieda process) in the back of their ankle. These bones can create friction in the ankle joint, causing this condition. Sometimes, small pieces of bone can break off and get compressed.

A common cause of posterior ankle impingement is chronic repetitive strain on the ankle due to playing sports or excessive training. Activities that require repetitive bending of the foot downward (plantar flexion) can contribute to this condition. Another cause of posterior ankle impingement is a trauma to the ankle that fractures small bones in the back of the ankle joint area.

Posterior ankle impingement is most common in these sports:

• Soccer
• Gymnastics
• Ballet/Dance – often referred to as a ballet dancer’s ankle due to its frequency in this population.
• Basketball
• Volleyball

Athletes with posterior ankle impingement usually feel sharp plantarflexion pain in the back of their ankle, especially when performing activities requiring their ankle to bend downwards. This plantarflexion pain may be particularly evident when dancing, kicking a ball, or walking downhill. Common symptoms also include:

• Pain that recedes to a dull ache when resting
• Tenderness to touch at the back of the ankle
• Feeling of ankle instability
• Pain when wearing high heels
• Visible or palpable posterior ankle swelling

If you have symptoms associated with posterior ankle impingement, you should see your doctor for an expert diagnosis. Your doctor will ask questions about your injury, the symptoms you’re experiencing, and the sports you play. A physical examination will identify areas of tenderness and posterior ankle swelling. Imaging tests, such as an X-ray or magnetic resonance imaging (MRI), help identify excessive bone formation or other conditions that may be causing your symptoms.

Treatment of posterior ankle impingement usually involves rest and avoiding activities that will aggravate your injury, such as dancing, kicking, running down hills, or jumping. Conservative treatments also include:

• Ice
• Elevation of the leg
• Compression
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, to relieve pain
• Corticosteroid injections for cases of severe inflammation
• Wearing a special ankle brace to support your ankle and protect it from re-injury
• Physical therapy exercises

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Posterior Ankle Impingement

Surgery is not common for treating posterior ankle impingement, but may be recommended for severe cases, especially if they do not improve with conservative treatment. Surgery allows the removal of bone or scar tissue. There are risks to having surgery. These include removing too much bone and causing instability. Another risk is restoring motion to an arthritic joint, which may cause increased pain. Surgeons may recommend performing the surgery arthroscopically, using minimally invasive techniques. Your doctor and orthopedic surgeon can advise if surgery is the best treatment option for you.

Recovery time after a posterior ankle impingement can vary widely and depends on the extent of the injury. Typically, it takes four to six weeks before athletes can get back to their normal activities. Recovery time can take longer for severe cases. Physical therapy will play an important role in an athlete’s recovery and return to play.