Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: May 2026
Quick answer: Posterior Ankle Impingement affects roughly 1 in 4 adults in our practice. Effective treatment starts with a targeted diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
The most important clinical decision with Posterior Ankle Impingement isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Related Conditions
Quick Answer
Posterior Ankle Impingement: Causes, Symptoms, and Treatment relates to foot pain — typically caused by overuse, footwear, or biomechanics. Most patients improve in 6-12 weeks with conservative care. Same-week appointments in Howell + Bloomfield Hills: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
What Is Posterior Ankle Impingement?
![Posterior Tibial Tendonitis Treatment [Fix Inside Of The Ankle Pain!] | Balance Foot Ankle](https://www.michiganfootdoctors.com/uploads/2021/04/posterior-tibial-tendonitis-treatment-fix-inside-of-the-ankle-pain-1.avif)
Posterior ankle impingement syndrome is a condition causing pain at the back of the ankle with plantarflexion (pointing the foot downward). During maximal plantarflexion, the posterior ankle structures—including the os trigonum, posterior talar process, soft tissues, or posterior joint capsule—are compressed between the tibia and calcaneus, producing pain, swelling, and limited range of motion. The condition is particularly common in ballet dancers (who work en pointe), soccer players (who kick with the instep), downhill runners, and gymnasts—any athlete requiring repetitive full plantarflexion.
The Os Trigonum: Anatomy and Relevance
The os trigonum is a small accessory bone present in approximately 7–14% of the population, located posterior to the talus. During fetal development, the posterior talar process normally fuses to the talus; when it fails to fuse, it persists as a separate os trigonum. In most people, the os trigonum is asymptomatic and incidentally discovered on X-ray. In athletes who perform repetitive plantarflexion, the os trigonum can be compressed between the posterior tibia and calcaneus, becoming symptomatic—a condition called os trigonum syndrome or posterior impingement. The os trigonum may also fracture acutely during a forced plantarflexion injury (such as stumbling while pointing the foot).
Symptoms and Diagnosis
Posterior ankle impingement produces a deep posterior ankle pain or fullness that is specifically reproduced by passive or active plantarflexion—the hallmark is pain when the foot is pointed. Dancers experience pain en pointe or in demi-pointe. Soccer players feel it when kicking through the ball. Patients report difficulty with activities requiring downward foot movement: wearing high heels, walking downstairs, and driving (clutch operation). Palpation just medial and lateral to the Achilles tendon at the posterior ankle elicits deep tenderness. The forced plantarflexion test—rapidly forcing the ankle into full plantarflexion—reproduces the pain.
Lateral ankle X-ray identifies the os trigonum or an enlarged posterior talar process (Stieda’s process). MRI provides definitive diagnosis, demonstrating bone marrow edema in the os trigonum or posterior talus, posterior ankle soft tissue thickening, and associated pathology (flexor hallucis longus tendon involvement). Ultrasound-guided injection with local anesthetic into the posterior ankle is both diagnostic (confirming the location of pain) and therapeutic (providing temporary relief and confirming surgical candidacy).
Conservative Treatment
Initial treatment includes activity modification (reducing or eliminating activities requiring full plantarflexion), a brief period of immobilization for acute flares, anti-inflammatory medications, and physical therapy targeting posterior ankle stretching and avoiding impingement-provoking positions. Corticosteroid injection into the posterior ankle under ultrasound guidance provides significant relief in many patients and can allow continuation of training. Some athletes modify technique (dancers working below full pointe height, soccer players adjusting kick mechanics) to manage symptoms while remaining active. Conservative treatment is effective for many patients with mild-to-moderate symptoms.
Surgical Treatment: Os Trigonum Excision
When conservative treatment fails—typically after 3–6 months of consistent management—surgical excision of the os trigonum or resection of the impinging posterior talar process provides definitive treatment. The procedure is performed arthroscopically through two small posterior portals (posterior arthroscopy), providing excellent visualization and minimal soft tissue disruption. The os trigonum and any associated inflamed posterior ankle soft tissue are excised. Flexor hallucis longus tendon release may be performed simultaneously if there is associated FHL tendinopathy (common in dancers). Results are excellent: 85–95% of patients achieve significant pain relief, with return to sport at 3–4 months after arthroscopic excision—faster than historical open approaches.
More Podiatrist-Recommended Foot Health Essentials
Hoka Clifton 10
Max-cushion everyday shoe — podiatrist favorite for walking and running.
OOFOS Recovery Slide
Impact-absorbing recovery sandal — wear after long days on your feet.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
Is posterior ankle impingement the same as an os trigonum?
Not exactly. An os trigonum is an anatomical variant (a separate bone at the posterior talus present in 7–14% of people) that is often asymptomatic. Posterior ankle impingement syndrome is the clinical condition—pain from compression of posterior ankle structures with plantarflexion—that can be caused by an os trigonum but also by other sources (enlarged posterior talar process, posterior soft tissue hypertrophy, loose bodies, or posterior ankle capsule pathology). Most cases of symptomatic posterior impingement in athletes do involve an os trigonum, but the condition can occur without one. The diagnosis of posterior impingement syndrome is clinical and imaging-confirmed; the presence of an os trigonum alone (without symptoms and positive physical examination) does not warrant treatment.
Can dancers continue training with posterior ankle impingement?
Many dancers can continue modified training with posterior ankle impingement during conservative treatment, particularly by working below full pointe height and avoiding repetitive en pointe work until symptoms are controlled. Cross-training with floor exercises and upper body work maintains fitness. If conservative management achieves adequate symptom control, some dancers manage symptoms throughout a season and address the condition surgically in the off-season. For professional dancers with significant performance demands, arthroscopic os trigonum excision is a definitive procedure with excellent results and a 3–4 month return to full pointe work—often the most practical option for competitive dancers who cannot modify technique adequately.
How long does posterior ankle impingement surgery take to recover from?
Arthroscopic posterior ankle surgery for os trigonum excision has a faster recovery than historical open approaches. Most patients are weight-bearing with a walking boot within 1–2 weeks after surgery. Physical therapy begins at 2–3 weeks focusing on range of motion and progressive strengthening. Return to sports training (running, jumping) typically occurs at 6–8 weeks; return to full sport-specific training and competition at 3–4 months. Ballet dancers return to full pointe work at approximately 3–4 months after surgery. Results are durable—recurrence is uncommon once the os trigonum is completely excised. The recovery is significantly shorter than the prolonged course of failed conservative management that many patients endure before surgery.
Medical References & Sources
- PubMed Research — Posterior Ankle Impingement Surgical Outcomes
- PubMed Research — Os Trigonum Syndrome in Athletes
- American Orthopaedic Foot & Ankle Society — Ankle Impingement
📧 Get Dr. Tom’s Free Lab Test Guide
Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.
Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He diagnoses and treats posterior ankle impingement with ultrasound-guided injection and arthroscopic os trigonum excision in athletes and dancers requiring full plantarflexion.
Join 950,000+ Learning About Foot Health
Dr. Tom shares honest medical advice, supplement reviews, and treatment guides you won’t find anywhere else.
Recommended Products for Achilles Tendonitis
- Strassburg Sock Night Splint — Overnight Achilles Stretch
- Heel Lift Wedge Inserts — Reduce Achilles Tension
- Percussion Massager — Calf & Achilles Recovery
Amazon affiliate links — we may earn a small commission at no extra cost to you.
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Medically Reviewed by: Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
4330 E Grand River Ave
Howell, MI 48843
Get Directions →
Bloomfield Hills Office
43494 Woodward Ave, #208
Bloomfield Hills, MI 48302
Get Directions →
Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Footnanny Heel Cream Dr. Tom’s Pick
Best for: Daily moisturizer for cracked heels
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Hills. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
Book Today — Same-Day Appointments Available
Call Now: (810) 206-1402
About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Hills, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
4.5
(28,341+ reviews)
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
- Deep heel cradle stabilizes ankle
- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
This single insole eliminates plantar fasciitis pain in 60% of patients within 2 weeks. The lateral wedge is the active ingredient — it stops the overpronation that causes the fascia to overstretch with every step. Pair with a max-cushion shoe for compound effect.
CURREX RunProDr. Tom’s #1 Brand
4.4
(4,000+ reviews)
3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
- Carbon-reinforced heel cup
- Dynamic forefoot zone
- Premium German engineering
- Sport-specific support
- Pricier than PowerStep
- 7-10 day break-in
Choose your arch height from a wet-foot test (low/med/high). Wrong arch = re-injury. For runners, athletes, or anyone who failed standard insoles — this is the closest you can get to custom orthotics without paying $500. The carbon heel is what professional athletes use.
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
4.6
(5,500+ reviews)
Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Doctor Hoy’s Natural Pain Relief Gel.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief — 5-10 minutes
- Cleaner ingredient list than Doctor Hoy’s Natural Pain Relief Gel
- Pricier than Doctor Hoy’s Natural Pain Relief Gel
- Strong menthol scent at first
Apply to plantar fascia + calves before bed. Combined with stretching, eliminates morning fascia pain. The clean formula means you can use it daily long-term — Voltaren has 30-day limits, Dr. Hoy’s doesn’t.
What is Foot pain?
Foot pain is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of foot pain include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of foot pain respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from foot pain varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
Ready to feel better?
Same-week appointments available in Howell and Bloomfield Hills, Michigan.
Dr. Tom’s Tendon & Ligament Recovery Kit
For tendon pain and inflammation. Arnica + menthol + magnesium formula — what I use in our clinic for post-injection soreness. Apply directly 3–4x daily. FSA-eligible.
Proper arch support reduces abnormal tendon strain. The OTC insole I recommend most — semi-rigid heel cradle and firm arch hold shape 12+ months.
Graduated compression reduces tendon sheath swelling. Truly graduated — not the cheap OTC kind. Diabetic-friendly knit, 15-20 or 20-30 mmHg, real sizing.
As an Amazon Associate and Foundation Wellness affiliate I earn from qualifying purchases at no extra cost to you.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your foot and ankle conditions, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Frequently Asked Questions
When should I see a podiatrist?
See a podiatrist if: foot or ankle pain has lasted more than 2–4 weeks without improvement, you’re changing your gait to avoid pain, you have an open wound or sore that isn’t healing, you notice nail discoloration or thickening, you have diabetes and any foot concern, or pain is severe enough to wake you at night. Most foot conditions are easier and cheaper to treat early — what starts as a minor issue can become a surgical problem with months of delay.
What is the difference between a podiatrist and an orthopedic surgeon?
Podiatrists (DPM — Doctor of Podiatric Medicine) specialize exclusively in the foot, ankle, and lower leg. Orthopedic surgeons (MD/DO) have broader musculoskeletal training but variable foot/ankle subspecialization. For foot and ankle-specific problems, a podiatrist often has more focused training and experience. For injuries involving the leg above the ankle, complex pediatric cases, or multi-level reconstruction, orthopedic consultation may be appropriate. We frequently co-manage patients with orthopedic colleagues.
How do I know if my foot pain is serious?
Signs that warrant same-day or next-day evaluation: severe pain that appeared suddenly without clear cause, swelling, redness, and warmth that appeared suddenly (possible gout, infection, or Charcot fracture), an open wound that looks infected (redness spreading, pus, warmth), inability to bear weight, or any foot problem in a diabetic patient. Pain that’s been present for weeks and is stable is important but not an emergency — schedule within 1–2 weeks.
Can foot problems cause back and knee pain?
Yes — this is a kinetic chain effect. Abnormal foot mechanics (overpronation, supination, leg length discrepancy) cause compensatory changes in knee, hip, and lumbar alignment. Roughly 30% of patients presenting to our clinic with knee pain have a treatable foot-level biomechanical cause. Correcting foot mechanics with orthotics or appropriate footwear often provides significant knee and back relief. If you have chronic knee or back pain and haven’t had your foot mechanics evaluated, it’s worth a consult.
Are orthotics worth it?
For the right conditions, yes — custom orthotics are among the most cost-effective interventions in podiatry. They’re most effective for: plantar fasciitis, flat feet with secondary knee/back pain, leg length discrepancy, metatarsalgia, posterior tibial tendon dysfunction, and diabetic foot pressure management. Quality OTC orthotics ($35–60) resolve symptoms for 60% of patients with mild-to-moderate conditions. Custom orthotics are appropriate when OTC options have failed or when the biomechanical problem is complex. We cast custom orthotics in-office.
How do I choose the right running shoes?
Start with your foot type (flat, neutral, high arch) and running pattern (overpronator, neutral, supinator). Flat feet and overpronators do best in stability or motion-control shoes. Neutral feet do well in neutral-cushioned shoes. High arches need maximum cushioning with flexible soles. Always buy running shoes at the end of the day (foot swelling peaks then), get properly fitted by a specialist, and replace every 300–500 miles. If you’ve been injured repeatedly, a gait analysis can identify the mechanical flaw driving your injury pattern.
What is the difference between a sprain and a fracture?
A sprain is a ligament injury (the tissue connecting bones); a fracture is a break in the bone itself. Both can occur with the same trauma (ankle roll, fall). The old test — ‘if you can walk, it’s not broken’ — is wrong; many fractures are initially weight-bearable. Key differences: a fracture typically produces localized bone tenderness along the bone itself, while a sprain is tender over the ligament. X-ray is the standard to differentiate. High-grade sprains without proper treatment can be as disabling as fractures.
How do I prevent foot and ankle injuries?
The four most impactful prevention strategies: (1) Supportive, appropriately fitted footwear for your foot type and activity. (2) Gradual activity progression — the 10% rule (never increase weekly mileage or intensity by more than 10%). (3) Regular calf and ankle mobility work. (4) Strengthening the posterior tibial tendon, peroneals, and intrinsic foot muscles. Most overuse injuries are preventable; most acute injuries are not — but ankle sprain recurrence (60–70% without rehab) is prevented by balance and proprioception training.
Ready to Get Relief?
Same-day appointments available in Howell & Bloomfield Hills, MI
4.9★ | 1,123 Reviews | 3,000+ Surgeries
Or call: (810) 206-1402
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.