Posterior Ankle Impingement

Treatment for Posterior Ankle Impingement

Posterior ankle impingement syndrome causes pain and swelling in the back of your ankle. It’s a classic injury for ballet dancers, as it is often caused by your ankle bones jarring against each other as you point your toe. It is also common in anyone who is involved in repeated kicking or stretching of the foot – such as footballers, gymnasts and rugby players. Posterior impingement can also be the result of an ankle sprain.

Early diagnosis is always advisable for treating ankle impingement – often reducing the need for surgery and improving your chances of a quick and full recovery.

If you experience posterior impingement symptoms of pain and swelling in the back of your ankle, particularly when you point your toes, contact the Capital Orthopaedics for an appointment.

What is posterior ankle impingement?

The base of your tibia (lower leg bone) rests and pivots on the dome-shaped talus (ankle bone) in your ankle joint. The bone surfaces are coated with slippery cartilage to aid smooth movement. The bones of your ankle are connected, stabilised and mobilised by ligaments and tendons (flexor hallucis longis and the Achilles tendon). The whole ankle joint is encased in a fluid-filled membrane called a joint capsule.

When you point your toes (plantar flexion), the bones at the back of your ankle compress. A forceful or very repetitive compression of your ankle can lead to soft tissues getting trapped between the bones – resulting in pain, swelling and reduced range of motion.

Damaged ligaments, tendons or joint capsule become swollen as a result of repeated stress or a sprain. The thicker tissues are likely to get pinched in the bones, and repeated plantar flexion leads to worsening problems.

If the bones of your ankle are repeatedly jarring against each other, your body may attempt to heal by producing extra bone at the point of damage. This bony lump (bone spur) can also cause soft tissues to become pinched.

What causes posterior impingement?

Posterior impingement is particularly common in the following athletes:

  • Ballet dancers
  • Footballers
  • Cricket fast bowlers
  • Gymnasts

Posterior impingement can also be the result of poor rehabilitation after an ankle sprain.

Some people have a naturally occurring extra piece of bone (either an os trigonum or a Steida process) at the back of the talus. These anatomic variants can cause posterior impingement, particularly in more active people.

Posterior impingement symptoms

Typical symptoms include:

  • Sharp pain at the back of your ankle joint when you point your toes
  • Swelling or tenderness as the back of your ankle
  • Instability
  • Aching when you are at rest, or after activities such as:
    • Kicking a ball
    • Pointe work (ballet)
    • Walking or running (especially downhills)
    • Jumping or hopping
    • Activities on tiptoes

How can Capital Orthopaedics treat posterior ankle impingement?

Our consultants diagnose posterior ankle impingement based on your history and a physical examination, followed by an x-ray or CT scan of different aspects of the ankle joint. An MRI scan is used to identify bone and soft tissue damage.

The treatments we provide depend on the extent of the ankle impingement.

Conservative treatments

Physical therapy: you will normally require a period of rest, followed by physiotherapy exercises to improve range of motion, increase strength and improve proprioception. We offer sports-specific training programmes as part of your rehabilitation.
Injections: steroids to reduce inflammation, and plasma to aid healing of damaged soft tissues


In persistent cases of ankle impingement – especially for professional and high-level athletes and dancers – our expert consultant orthopaedic surgeons carry out minimally invasive procedures to remove bone spurs, smooth damaged bone and cartilage (debridement) or remove swollen soft tissue.

Get in touch with Capital Orthopaedics

Offering the most sophisticated surgical techniques, state-of-the-art diagnostics, dedicated physiotherapy programmes and advanced injection therapies in three central London locations, the Capital Orthopaedics team is dedicated to giving you the optimal treatment with the least intervention and the quickest recovery times.


Other ankle conditions we treat

Torn Ankle Ligament Injury

A sprained ankle can cause the ligaments to tear. We initially treat torn ankle ligaments with physiotherapy to build up strength and mobility. For more serious ruptures or ongoing ankle instability, we use minimally invasive surgery to repair ligaments, damaged bone or cartilage.

Ankle Osteoarthritis

Osteoarthritis is caused by repetitive impact, injury or ageing. The slick cartilage coating in joints can wear away or get torn – and the exposed bones start to degenerate. As bones try to heal, lumps called bone spurs can form, causing friction in the joint. The result is soft tissue damage, pain, swelling and instability.

Peroneal Subluxation

The tendons that run under the bony lump on the outside of your ankle (usually after a sprain) can become displaced, resulting in pain, swelling and instability. Physiotherapy can build up the muscles and improve stability. For ongoing symptoms, arthroscopic surgery can be used to fix the tendon back in place.

Footballer’s Ankle

Anterior ankle impingement causes pain in the front of your ankle. Soft tissues can get pinched between the bones as you flex your foot upwards as a result of repetitive kicking or flexing actions. Pinching occurs as a result of scarring or inflammation, or a bone spur forming as a result of repeated jarring.

Frequently asked questions

Book an Appointment with an Orthopaedic Specialist

The Capital Orthopaedics team is made up of highly experienced medical professionals – from Mr Simon Moyes, the renowned orthopaedic consultant surgeon, to physicians, nurses, anaesthetists and physiotherapists.
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