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Posterior ankle impingement may be caused by bony or soft tissue structures: os trigonum syndrome, flexor hallucis longus tenosynovitis and injury to the posterior ligaments. The os trigonum is the most common cause of symptomatic posterior ankle impingement.
Most people are unaware that they have an os trigonum.
Os trigonum syndrome can be triggered by a single injury, such as an ankle sprain or caused by repetitive downward pointing of the toes, which is common among ballet dancers, soccer players and other athletes.
When pointing the toes downward, the os trigonum can become crunched between the ankle and heel bone, resulting in a “nutcracker injury.” As the os trigonum is moved, the tissue connecting it to the talus is stretched or torn and the area becomes inflamed.
The Sajid Shariff clinic is a private orthopaedic clinic based in SE London and Kent that specialises in surgical and non-surgical treatment of foot and ankle conditions including ankle sprains, bunions, plantar fasciitis and achilles tendonitis.
Keep an eye on the shape of your feet; if you see changes see a doctor to find out if there are any recommendations to prevent hallux valgus from forming
Strengthen your feet by exercising them
Wear shoes that fit your feet well and offer good support
Try to avoid shoes that have a heel or pointed toe
After taking a history the foot and ankle are examined, x-rays or other imaging tests (MRI scans) are often required to make the diagnosis.
For milder sprains, the simple home treatment follows the RICE protocol:
RICE: Rest Ice Compression Elevate
Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help control pain and swelling.
Some sprains will require treatment in addition to the RICE protocol and medications.
Most patients improve with non-surgical treatment. If the pain persists the surgery may be required to relieve the symptoms. Surgery typically involves removal of the os trigonum, as this extra bone is not necessary for normal foot function.
Other types of Posterior Ankle Impingement
Posteromedial impingement: Following injury to the Posterior Tibiotalar ligament
Posterolateral impingement: Following injury to the Posterior Talofibular Ligament (PTFL)