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Ankle Pain

Posterior Ankle Impingement

Minute Read


Posted 10 months ago


Last updated: 03/10/2022


by James McCormack

Posterior Ankle Impingement: Anatomy

The ankle joint comprises the lateral and medial malleoli and the talus bone. There are ligaments and tendons connecting these three bones whose function is to provide stability to the joint. Hard, shiny cartilage protects the bone from impact and damage on the end of each bone. At the back of the ankle joint, if there is irritation to the cartilage of these bones, it is called a Posterior Ankle Impingement.

Posterior Ankle Impingement Symptoms

The primary symptoms of Posterior Ankle Impingement are pain and swelling at the back of the ankle. Symptoms are eased by pointing the toes upwards. Posterior Ankle Impingements are usually aggravated by raising the heel off the floor or pointing the toes in a non-weight-bearing position.

In irritable cases of Posterior Ankle Impingement, there may be a low-level dull ache at rest, while wearing high heels irritates the posterior ankle. It may be tender to touch and can be misdiagnosed as Achilles Tendonitis.

Causes of Posterior Ankle Impingement

Two causes of Posterior Ankle Impingement are a bony growth called a Stieda Process, or an extra bony formation called an Os Trigonum.

When lifting the heels off the floor, it closes the joint at the back of the ankle, and if there is an extra bony growth, it can pinch the joint causing pain and swelling,

Repetitive Trauma to the back of the ankle from kicking a ball, jumping, or going en-pointe can irritate and back of the ankle, causing pain and swelling.

In Ballet Dancers, this condition is referred to as Dancer’s Heel.

Posterior Ankle Impingement is commonly seen in:

  • Ballet Dancers
  • Gymnastics
  • Football
  • Jumping Sports
  • Running Downhill


A clinical examination with a medical professional such as a Physical Therapist or a Sports Medicine Doctor is recommended for symptoms of Posterior Ankle Impingement. A careful clinical interview followed by a physical assessment can ascertain if it is likely that Posterior Ankle Impingement is present.

To confirm the diagnosis a clinician may refer you for an MRI scan as this can identify bone spurs, swelling or inflammation in the back of the ankle.

Related Article: Posterior Ankle Impingement: Tests and Diagnosis

Posterior Ankle Impingement Treatment

Posterior Ankle Impingement treatment with a Physical Therapist is recommended to resolve the condition. Treatment can involve ankle mobilisations, soft tissue massage, and strengthening and stability exercises.

Taping, custom insoles, and footwear modifications can also help to relieve pain. A gait analysis may be required to address any biomechanical issues.

If symptoms fail to settle with these strategies, you may require an ultrasound-guided steroid injection to reduce pain and swelling in the area.

Surgery may be performed to remove an Os-Trigonum or any bony spurs, such as a Stieda process if conservative management is unsuccessful. This is usually followed by 4-6 weeks of rehabilitation with a Physical Therapist.

Related Article: Posterior Ankle Impingement Exercises

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.

Related Article: Wy do my ankles hurt when I run?

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