Posterior Ankle Impingement

What is it?

Posterior ankle impingement is a condition characterised by tissue damage at the back of the ankle joint due to compression of these tissues during maximal ankle plantarflexion. This condition is commonly associated with ballet dancers who require extreme range of motion in their ankle joint to achieve the en pointe position.  The impingement may associated with poor ankle joint mobility causing the tissues to become damaged when forcing the foot to an en pointe position. Soft tissue impingement can be caused by thickening or irritation of the FHL tendon, posterior joint capsule thickening or synovitis. In other cases a separate extra bone (os trigonum) may develop or extra bony growth on the talus may prevent the dancer from obtaining full ankle plantarflexion.

Symptoms?

People with this condition often feel pain behind the heel or deep behind the ankle joint. The pain is usually worse when the foot is in a maximal plantarflexion position.

Treatment

Initially conservative management should be the first line approach. This includes a period of rest and occasionally an immobilising boot be may be required. Physical therapy such as myofascial release, low level laser therapy, joint mobilisation and taping can help settle symptoms. Rehabilitation should address any biomechanical anomalies, muscular weaknesses or poor athletic technique that may be contributing to the development of the syndrome.

In extreme cases or cases that do not respond to conservative care, a surgical opinion may be required.