Ankle Impingement (Posterior) Causes, Symptoms & Treatment

Overview

Ankle impingement (posterior) is a condition that causes pain in the back of the ankle, particularly during movements that point the toes downward. It occurs when soft tissue or small bony structures between the shin bone (tibia) and heel bone (calcaneus) become compressed, leading to inflammation and discomfort.

In some cases, a small bone (os trigonum) or a bony projection (Stieda process) can create friction, and occasionally, tiny bone fragments may also become trapped, worsening the condition.

This condition is common in athletes who engage in sports that involve rapid acceleration, jumping, or extreme ankle movements, such as soccer, running, and ballet, and has historically been referred to as “athlete’s ankle” or “footballer’s ankle.”

What causes Ankle Impingement (Posterior)?

Posterior ankle impingement often develops due to chronic, repetitive strain on the ankle from sports or intense training. Movements involving repeated downward bending of the foot (plantarflexion) can aggravate the condition. It may also result from trauma that causes fractures of small bones at the back of the ankle joint.

• How the Injury Occurs: Repeated forced extension of the ankle during jumping, landing, or toe push-offs compresses soft tissues at the back of the joint, causing irritation and swelling.
• Common Everyday Causes: This can occur in non-athletes with repetitive ankle movements, such as dancers on hard floors, frequent squatters or kneelers, and workers maintaining plantarflexed positions for long durations.

Posterior ankle pain is most common in the following sports:

• Soccer: Repeated kicking and quick directional changes strain the ankle.
• Gymnastics: Continuous landings and pointed toe positions increase joint compression.
• Ballet/Dance: Often called “ballet dancer’s ankle” due to its frequency in this population.
• Basketball: Frequent jumping and abrupt stops stress the posterior ankle.
• Volleyball: Repetitive jumps and landings heighten pressure on the ankle joint.

Symptoms

Athletes with posterior ankle pain usually experience sharp pain in the back of the ankle during plantarflexion, especially when performing activities that require the ankle to bend downward. This pain is often noticeable when kicking, running downhill, or performing similar movements.

Common symptoms include:

• Pain that eases to a dull ache at rest
• Tenderness when touching the back of the ankle
• A sense of ankle instability
• Discomfort when wearing high heels
• Visible or palpable swelling at the back of the ankle

Non-operative treatment

Management typically focuses on rest and avoiding activities that worsen symptoms, such as kicking, jumping, running downhill, or repetitive plantarflexion movements. Conservative treatment options include:

• Ice: Reduces swelling and pain after activity.
• Elevation: Keeps the leg raised to minimize inflammation.
• Compression: Supports the ankle and limits excessive movement.
• NSAIDs: Medications such as ibuprofen or naproxen relieve pain and inflammation.
• Corticosteroid injections: Used for significant inflammation or persistent pain.
• Ankle brace: Provides stability and protects against further injury.
• Physical therapy: Improves strength, flexibility, and restores normal ankle motion.

Try these exercises to help manage your condition:
Below is a PDF of the Exercise Program

Posterior Ankle Impingement

Surgical Treatment

Surgery for posterior ankle impingement is generally reserved for severe cases that do not respond to conservative treatment. The procedure aims to remove bone or scar tissue causing compression and discomfort. Potential risks include excessive bone removal, which may lead to joint instability, or increased pain if motion is restored in an arthritic ankle.

Minimally invasive arthroscopic resection techniques are often preferred to reduce recovery time and tissue trauma. Decisions regarding surgery should be made in consultation with an orthopedic specialist, who can assess the severity of the condition and determine whether operative intervention is the most appropriate option.