All you need to know about Posterior Ankle Impingement

Posterior Ankle Impingement (PAI) is characterised by major pain around the back of the ankle, which is caused by compression of the soft tissue or bone structures during activities that involve maximal ankle plantar flexion. The condition is also often referred to as Posterior Impingement Syndrome, Ankle Impingement, Trigonum Syndrome or Posterior Impingement of the Ankle. PAI involves the ankle being compressed during plantar flexion when the foot and the ankle are maximally pointed away from body. This can cause pain and tissue damage if the forces of compression are too strong or repetitive.

Causative factors of Posterior Ankle Impingement

PAI often affects athletes, including:

• Gymnasts
• Footballers
• Ballet dancers
• Cricket Fast Bowlers (in the landing leg or front leg)

PAI frequently occurs because of inadequate rehabilitation after a serious ankle injury. Sometimes an individual might have some kind of anatomical variant within their talus bone that is known as Os Trigonum, leading to PAI symptoms.

Posterior Ankle Impingement Symptoms

Posterior Ankle Impingement symptoms include:

• Pain after provocative activities or while at rest
• Sharp pains felt at the back of the ankle joint during maximal plantar flexion

Some examples of provocative activities that may cause pain include:

• Kicking a ball
• Hopping or jumping
• Dancing or other kinds of Pointe work
• Activities carried out on ‘tip-toes’
• Running or walking (especially downhill)

Diagnosis of Posterior Ankle Impingement

Posterior Ankle Impingement can be diagnosed following a physical assessment and taking into account personal history. Diagnosis may also involve a number of imaging techniques like X-Rays and MRI scans to detect the severity of the condition.

Treatment of Posterior Ankle Impingement

The treatment of Posterior Ankle Impingement is usually carried out in a number of different phases. Some of these are briefly described below:

• Reducing the pain, minimizing the swelling and protecting the affected area from additional injury
• Restoring complete range of motion
• Restoring muscle strength
• Restoring power, high speed, agility and proprioception
• Returning to regular daily functioning and sport

Surgery for Posterior Ankle Impingement

Although surgery is not the first line of treatment for Posterior Ankle Impingement and it is not recommended often, in some persistent cases surgery may prove to be beneficial. In particular it is used to treat Posterior Ankle Impingement if the patient is a high level athlete. The nature of the specific case will determine the kind of surgery that needs to be carried out and most often involves removal of bone spurs or the affected soft tissues.

In some cases, additional methods of treatment such as injections, acupuncture and general exercises may also be used.