• Emma Martin

Posterior Ankle Impingement

Updated: Mar 8

Posterior Ankle Impingement (PAI) is a condition where pain is experienced at the back of the ankle, due to compression of the bone or soft tissue structures. The onset of pain is usually during activities that involve maximal ankle plantarflexion motion. Posterior ankle impingement is also known as ankle impingement, posterior impingement syndrome, and Os Trigonum syndrome. Often people suffering from PAI have moderate to severe limitation in activities of daily living due to pain.

What Does it Feel Like?

Symptoms may either develop slowly over a period of time, or in response to a sudden injury. Generally, individuals suffering from PAI experience sharp pain at the back of the ankle joint during activities that require maximal plantarflexion (such as pointing the toes), and an ache at rest or following aggravating activities.

Some activities that can aggravate symptoms include kicking a ball, pointe work (ballet), walking or running (especially downhill), jumping or hopping, or anything on “tip-toes”.

What Causes Posterior Ankle Impingement (PAI)?

Posterior ankle impingement can often occur due to inadequate rehabilitation following an acute ankle injury. In some cases, an individual may have an anatomical variant in their talus bone, known as Os Trigonum, which is actually quite normal. However, this variant can cause an increased likelihood of developing posterior ankle impingement.

PAI is a common injury in athletes engaging in repetitive plantarflexion, particularly ballet dancers, footballers, cricketers, soccer players, and gymnasts. This is due to the nature of these specific sports, with regards to the repetitive motion required at the ankle joint.

How can it be managed?

There are 5 phases of management for PAI. The first phase is to relieve pain, minimise swelling and prevent further injury. This can be done through resting the ankle and avoiding pain-provoking positions, ice, compression, and elevation. Phase two is to restore full pain free range of motion at the ankle joint. Phase three is to improve and restore muscle strength of the supporting structures. This can be done through rehabilitation programs that strengthen the ankle and improve the quality of movement, particularly during calf raises and ankle stability exercises. The fourth phase is to restore high speed, power, proprioception and agility, and then finally to return to normal daily function and sport.

If you experience pain at the back of your ankle, don't let it go unnoticed. Book an appointment with one of our Physiotherapists to see how your pain can be appropriately managed.


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