Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Posterior Ankle Pain in Dancers: Os Trigonum Syndrome and FH 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 Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
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Quick Answer
Most foot and ankle problems respond to conservative care — proper footwear, supportive inserts, activity modification, and targeted stretching — within 4-8 weeks. Persistent pain beyond that window, or any symptom that prevents walking, warrants a podiatric evaluation to rule out fracture, tendon tear, or systemic cause.
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Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Posterior ankle pain in dancers — particularly classical ballet dancers who repeatedly go en pointe or demi-pointe — has two common causes: os trigonum syndrome (impingement of the os trigonum between the tibia and calcaneus in forced plantarflexion) and flexor hallucis longus (FHL) tendinopathy or triggering. Both conditions produce posterior ankle pain with plantarflexion and are specifically associated with activities requiring maximal ankle plantarflexion. Distinguishing them is important because their surgical treatments are different, though they frequently coexist.
Os Trigonum Syndrome
The os trigonum is a secondary ossification center of the posterior talar process — present in 7–25% of the population — that fails to fuse with the talus and remains as a separate bone connected by a synchondrosis. In forced plantarflexion (ballet pointe position, football kicking, soccer striking), the os trigonum is compressed between the posterior tibia and the superior calcaneus — producing posterior ankle pain. Clinical features: posterior ankle pain reproduced with passive forced plantarflexion (the posterior impingement test); point tenderness posterior to the peroneal tendons in the retromalleolar-calcaneal space; the FHL tendon runs adjacent to the os trigonum and is often simultaneously inflamed. Imaging: lateral X-ray identifies the os trigonum; MRI shows edema at the synchondrosis and surrounding soft tissue inflammation. Conservative management: activity modification (reduce pointe work); corticosteroid injection at the os trigonum synchondrosis under ultrasound guidance; boot immobilization for acute flare. Surgical: posterior arthroscopic os trigonum excision — 6–8 weeks recovery; excellent results in dancers with early return to dance.
FHL Tendinopathy and Triggering
The FHL tendon passes through a fibro-osseous tunnel at the posterior ankle adjacent to the os trigonum — stenosis of this tunnel or FHL tendon thickening produces triggering (‘dancer’s tendinitis’): a palpable and audible clicking or snapping with active great toe flexion-extension, sometimes with the great toe intermittently locking in flexion. Treatment: FHL tendon sheath corticosteroid injection; FHL tendon sheath release (tenosynovectomy) when conservative management fails — usually performed concurrently with os trigonum excision when both are present. Dr. Biernacki at Balance Foot & Ankle evaluates posterior ankle pain with dynamic ultrasound and treats os trigonum syndrome and FHL tendinopathy in dancers and athletes. Call (810) 206-1402 at our Bloomfield Hills or Howell office.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
In-Office Treatment at Balance Foot & Ankle
If home care isn’t resolving your ankle pain, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.
Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.
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PowerStep Pinnacle Insole
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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
Athletic injuries heal faster with sport-specific rehab protocols — not generic rest and ice. Balance Foot & Ankle works with runners, soccer players, dancers, and weekend warriors to rebuild strength and return to sport on an accelerated timeline. Don’t let a foot injury keep you sidelined longer than necessary.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
How do I know if I sprained or broke my ankle?
Both cause pain, swelling, and difficulty walking. Key differences: fractures often cause more immediate severe pain, tenderness directly over bone (not just ligament), and inability to bear any weight. X-rays and the Ottawa Ankle Rules help determine if imaging is needed.
How long does an ankle sprain take to heal?
Grade I (mild): 1–2 weeks. Grade II (moderate): 3–6 weeks. Grade III (complete tear): 2–3 months. Chronic instability from improperly treated sprains can persist and may require surgery.
What is the best treatment for a sprained ankle?
RICE protocol (Rest, Ice, Compression, Elevation) for the first 48–72 hours, followed by protected weight-bearing as tolerated. Physical therapy rehabilitation is critical for high-grade sprains to restore strength and proprioception and prevent chronic instability.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Same-week appointments available at both locations.
Book Your AppointmentMost Common Mistake We See
The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Unable to bear weight
- Severe swelling with skin colour change
- Fever with foot pain (possible infection)
- Diabetes plus any new foot symptom
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
Watch: Dr. Tom explains
Podiatrist-recommended products
As an Amazon Associate, Dr. Tom earns from qualifying purchases.
Conservative os trigonum treatment – 4-6 weeks immobilization before considering excision.
View on Amazon →Posterior ankle cold therapy controls inflammation from impingement.
View on Amazon →Heel lift elements reduce posterior ankle impingement in cavus foot types.
View on Amazon →Topical anti-inflammatory for chronic posterior ankle symptoms.
View on Amazon →Related resources
Ready to solve this? Book today.
Same-week appointments · Howell & Bloomfield Hills · 4.9★ (1,123+ reviews)
☎ (810) 206-1402Book Online →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 Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
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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 Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon 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 reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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