Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
Posterior ankle impingement near Hartland is often driven by a small extra bone called the os trigonum that 1 in 10 people has and never knew about — until one specific movement triggers it. A single targeted injection confirms the diagnosis and often resolves the pain; if not, arthroscopic removal takes under an hour. Call (810) 206-1402 — posterior ankle pain evaluations in Hartland.
Medically Reviewed by: Dr. Tom Biernacki DPM · Board-Certified Podiatrist · Balance Foot & Ankle PLLC · Updated 2026
Posterior Ankle Impingement Treatment Near Hartland, MI
Posterior ankle impingement treatment near Hartland, MI is available at Balance Foot & Ankle in Howell. Dr. Biernacki DPM treats os trigonum syndrome and posterior ankle soft tissue impingement — causes of posterior ankle pain during plantarflexion (pointing the foot) — with injection and arthroscopic posterior ankle surgery. Call (810) 206-1402.
Posterior Ankle Impingement: Pain When Pointing the Foot
Posterior ankle impingement is a condition in which soft tissue or bony structures are compressed between the posterior aspect of the tibia and the calcaneus when the foot is plantarflexed (pointed). The most common cause is an os trigonum — an accessory ossicle behind the talus present in 7–14% of the population — that becomes symptomatic when repetitive plantarflexion traps it between adjacent bones. Soft tissue impingement from posterior ankle capsule thickening or scarring (often post-sprain) can produce identical symptoms without an os trigonum. The characteristic presentation is posterior ankle pain with forced plantarflexion — stepping downstairs, wearing high heels, or athletic push-off activities. In dancers performing en pointe, this is one of the most common injuries we see. In our Hartland-area non-dancer patients, it frequently presents as “posterior ankle tendinitis” resistant to standard treatment.
Key Takeaway: X-ray identifies an os trigonum; MRI confirms whether it is the active pain source (bone marrow edema signal). A diagnostic injection into the os trigonum region that relieves pain confirms the diagnosis. Arthroscopic excision has excellent outcomes with 6–8 week return to sport.
Treatment: Injection and Arthroscopic Surgery
Conservative treatment: Activity modification avoiding forced plantarflexion. Heel lift reduces posterior impingement stress. Fluoroscopy or ultrasound-guided corticosteroid injection into the posterior ankle — both diagnostic and therapeutic. 50–60% of patients achieve sufficient relief with injection and activity modification. Arthroscopic surgery: Posterior ankle arthroscopy via two posteromedial and posterolateral portals allows direct visualization and excision of the os trigonum and release of soft tissue impingement lesions. Minimal-invasive technique with excellent outcomes — most patients return to full sport in 6–8 weeks. Superior to open surgery in recovery time and complication profile.
⚠️ See a Podiatrist If:
- Posterior ankle pain specifically worsened by pointing the foot (plantarflexion)
- Pain going downstairs or wearing high-heeled shoes
- Posterior ankle pain in a dancer, gymnast, or soccer player
- Prior diagnosis of “posterior ankle tendinitis” not responding to standard treatment
- MRI or X-ray showing an os trigonum with clinical symptoms correlating to the finding
Recommended Products for Ankle Impingement Recovery
Reducing anterior or posterior ankle impingement pain at home starts with the right support. Dr. Biernacki recommends these clinically appropriate products for our patients managing ankle impingement symptoms.
ASO Ankle Stabilizing Orthosis Brace
The ASO brace is the gold standard for ankle support used in our clinic. Its lace-up design with figure-eight straps limits excessive dorsiflexion and plantarflexion — the movements that provoke impingement pain. Lightweight enough for all-day wear inside regular shoes. Available in multiple sizes.
Bauerfeind MalleoTrain Ankle Support
Medical-grade knit compression sleeve with anatomical inserts that apply targeted massage to the ankle joint during movement. Reduces swelling, improves proprioception, and decreases soft tissue irritation around the ankle. Excellent for patients with posterior impingement who need compression with mobility. Machine washable.
Getting to Our Office From Hartland
Our Howell office at 4330 E Grand River Ave, Howell, MI 48843 is about 10 minutes from Hartland via US-23 or M-59. We accept most major insurance. Call (810) 206-1402 or book online.
Posterior Ankle Pain? Get Precise Diagnosis
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📋 Dr. Tom Biernacki, DPM, FACFAS answers:
Posterior ankle impingement near Hartland causes pain at the back of the ankle during plantarflexion — pointing the foot down. It is common in ballet dancers, soccer players, and anyone who repeatedly loads the posterior ankle. Our podiatrist serving Hartland identifies contributing factors such as an os trigonum (an accessory bone), a prominent posterior talar process (Stieda process), or hypertrophic soft tissue. Conservative treatment includes rest, ice, anti-inflammatory medications, physical therapy, and cortisone injections. When an os trigonum or bony prominence is identified and symptoms persist, arthroscopic excision is performed through small posterior portals. Recovery is typically four to six weeks. Patients near Hartland who undergo surgery experience high satisfaction rates and return to their sport or activity without restriction.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.
More questions patients ask
What causes posterior ankle impingement syndrome?
Posterior ankle impingement occurs when soft tissue or a bony prominence (often an os trigonum — an accessory bone behind the ankle) is compressed between the tibia and calcaneus during plantarflexion (pointing the foot downward). It's the classic 'ballet dancer's ankle' injury, but also affects soccer players who repeatedly plantarflex at impact. The os trigonum is present in 7% to 14% of people and remains asymptomatic until a specific forceful plantarflexion movement triggers compression and inflammation.
How is posterior ankle impingement treated?
Initial treatment involves activity modification to avoid forced plantarflexion, anti-inflammatory medications, and a corticosteroid injection into the posterior ankle space to reduce inflammation around the impinged tissue or os trigonum. Physical therapy addresses calf flexibility and posterior ankle joint mechanics. When an os trigonum is confirmed as the source and conservative treatment fails after 3 to 6 months, surgical excision of the os trigonum — either arthroscopically or through a small open incision — provides reliable and often rapid relief.
How long is recovery after os trigonum removal surgery?
Arthroscopic os trigonum excision allows weight bearing within days and return to sports at 6 to 10 weeks in most cases. Open surgical removal typically requires 2 to 3 weeks non-weight bearing and return to sport at 3 to 4 months. Results are generally excellent — most athletes return to full activity at their pre-injury level. Early postoperative physical therapy focusing on range of motion and strength recovery is important for optimal outcomes.
Still have a question about coverage or cost? Book online and we will check your benefits before your visit: Book in Howell · Book in Bloomfield Township. Prefer to talk it through first? Call (810) 206-1402.