Posterior ankle impingement

This refers to entrapment or pinching of tissues at the back of the ankle joint between the tibia and the talus. When the foot is brought fully downwards into a tiptoe position the space between these two bones is at a minimum and it is at this point that impingement can occur. This can cause inflammation and swelling which then makes the tissues more likely to get pinched. There can be impingement of the soft tissues or of bone, and this can lead to the formation of bony spurs (osteophytes) around the joint. This is common in ballet and kicking sports. It can be related to an enlarged bone fragment at the back of the ankle called an 'os trigonum'.

You will experience pain at the back of the ankle joint, usually much worse when in the tip toe position. You may also notice a reduced amount of movement in the joint.

If you think you have this condition it is well worth getting it checked out by Mr Willis-Owen. In the mean time you should avoid any aggravating activities which may prolong the problem. It generally won't get better on its own. Anti-inflammatories and ice are helpful after exercise.

Treatment involves first confirming the diagnosis with a careful examination and X-rays. An MRI scan can be useful to exclude other problems and confirm the diagnosis. Treatment options may include specific physiotherapy, and injections. Sometime keyhole surgery is needed to remove some of the tissue that is getting pinched or shave away some of the bone to make more room, or remove the os trigonum. Once you are recovered it is important to address any biomechanical problems or other underlying factors in order to prevent recurrence.