Pain Is Not a Prerequisite for Greatness
In the world of gymnastics, athletes are taught to push through boundaries. You understand discipline, repetition, and the difference between 'sore' and 'injured.' While the bumps and bruises from a new skill are part of the process, the sharp, stabbing, or pinching pain you feel in your ankle on every landing is not.
Too many gymnasts accept chronic ankle pain as 'part of the sport,' 'crunching' their ankles on landings and hoping it goes away. But this persistent pain is often a warning sign—a signal of a structural problem that 'rest and ice' alone cannot solve. It’s a sign that the joint's mechanics are compromised, which can limit your performance, shorten your career, and lead to long-term problems like arthritis.
As a board-certified orthopaedic surgeon specializing in complex foot and ankle conditions, I have a special focus on high-performance athletes, including dancers and gymnasts. These athletes place unique, high-impact demands on their ankles, leading to a specific cluster of injuries that are often misunderstood or undertreated.
This guide is designed to help you, your parents, and your coaches understand what that ankle pain is telling you. We will break down the most common gymnast ankle injuries—from instability to impingement—and explain the advanced, minimally invasive surgical options that can fix the underlying problem, restore your stability, and get you back to the mat, stronger and more confident than before.
The Anatomy of a Gymnast's Ankle: A High-Impact Specialist
A gymnast's ankle is a feat of engineering, built for both explosive power and delicate grace. But the demands of the sport push it to its absolute limits.
- High-Impact Forces: Repetitive, high-impact landings from tumbling passes, vaulting, and dismounts place enormous stress on the bones, cartilage, and ligaments.
- Extreme Plantar Flexion: The 'toe point' (plantar flexion) required for aesthetics and technique is a position of biomechanical vulnerability, placing unique stress on the back of the ankle.
This combination of repetitive high-impact force and extreme range-of-motion makes gymnasts uniquely susceptible to chronic overuse injuries. When these injuries create structural damage—like torn ligaments, bone spurs, or cartilage defects—physical therapy alone may not be enough.
Mapping Your Pain: From Common Sprains to Career-Threatening Conditions
Pain is a signal. By learning to identify where and how your ankle hurts, you can understand the specific problem and its solution.
Here is a simple map of common symptoms gymnasts experience and the conditions they often point to.
Table 1: Gymnast's Ankle Injury Symptom-to-Solution Map
1. The 'Rolled Ankle' That Never Heals: Chronic Ankle Instability (CAI)
What it is: The ankle sprain is the most common acute injury in gymnastics. But when the ligaments are overstretched or torn, they often don't heal with the same tension. This leads to Chronic Ankle Instability (CAI), a condition where the ankle feels weak, wobbly, or 'gives way' unexpectedly. Gymnasts, in particular, have the highest rate of persisting symptoms after an initial sprain. For a Level 10 gymnast, this instability can be a career-threatening challenge, making tumbling and vault landings dangerously unpredictable.
When Conservative Care Fails: Physical therapy is essential for retraining the muscles around the joint (proprioception). But if the ligaments are too damaged, no amount of strengthening can make them 'tight' again.
Advanced Surgical Solution: For athletes with CAI, an Ankle Ligament Reconstruction (such as a modified Broström procedure) is the criterion standard. This procedure is designed to anatomically repair and tighten the damaged outer ligaments, restoring the ankle's native stability. For high-demand athletes, this procedure is highly effective, allowing a functional return to their pre-injury level of activity.
Is your ankle feeling weak or unreliable? Learn more about your options for Ankle Ligament Reconstruction at our Pittsburgh-area practice.
2. The 'Crunched Ankle': Anterior Ankle Impingement
What it is: This is the classic 'stinging pinch' in the front of the ankle, felt most acutely when landing a tumbling pass or performing a deep squat. It's often caused by the biomechanics of the sport: tight calf muscles (from explosive jumping) limit the ankle's ability to bend, causing the bones and soft tissues in the front of the joint to 'crunch' or 'pinch' upon landing. Over time, this repetitive 'crunching' can lead to chronic inflammation, scar tissue, and even bone spurs.
When Conservative Care Fails: Stretching the calf muscles and working on mobility are the first lines of treatment. However, if scar tissue or bone spurs have already formed, they create a physical block that stretching cannot remove.
Advanced Surgical Solution: Ankle Arthroscopy is a minimally invasive 'keyhole' surgery used to fix this. Using a tiny camera and specialized instruments inserted through small incisions, a surgeon can look inside the joint, clean out the inflammatory scar tissue, and remove any bone spurs that are causing the 'crunch.' This procedure is highly effective at relieving the 'pinching' and restoring a smooth range of motion, with a reduced recovery time.
If stretching hasn't stopped the 'pinch,' you may have a structural block. An Ankle Arthroscopy may be needed to clean out the joint.
3. The 'Pointer's Pinch': Posterior Ankle Impingement & Os Trigonum Syndrome
What it is: This is a deep, aching pain felt in the back of the ankle. It is triggered by the extreme 'toe point' (plantar flexion) common in gymnastics. This pain is often caused by a 'hidden' anatomical variant: the Os Trigonum. This is a small, extra bone that is present in about 20% of the population. It normally causes no problems, but in gymnasts and ballet dancers, this extra bone can get 'squeezed' or impinged between the ankle and heel bones when pointing the toes, leading to inflammation and pain.
When Conservative Care Fails: Rest and anti-inflammatories may calm the pain temporarily, but as soon as the athlete returns to the demands of their sport, the bone and tissue get 'pinched' again.
Advanced Surgical Solution: This is a specialized condition that requires a specialist. Our practice is experienced in treating this exact injury in dancers and athletes. The solution is a minimally invasive procedure called Hindfoot Endoscopy (or Posterior Ankle Arthroscopy). Using a camera and instruments inserted from the back of the ankle, the surgeon can remove the problematic os trigonum bone, relieving the impingement without disrupting the main ankle joint. Studies on this procedure show it has minimal surgical morbidity, a short recovery time, and allows athletes to return to their sport in as little as 8 to 9 weeks.
This 'back pinch' is a common problem for gymnasts. Dr. Prisk is a specialist in Hindfoot Endoscopy for Os Trigonum Syndrome.
4. The 'Deep Ache' and 'Click': Osteochondral Lesions (OCD)
What it is: This pain is different. It's not always a sharp 'pinch' but rather a 'deep, persistent ache' inside the joint. You may also feel a 'clicking,' 'popping,' or 'locking' sensation, or a feeling of weakness. An Osteochondral Lesion (OCD) is essentially a 'pothole' in the joint—an injury to the smooth cartilage and the bone underneath it, often caused by repetitive stress or as a 'collateral event' from a bad ankle sprain.
When Conservative Care Fails: The cartilage tissue in our joints has a very poor ability to heal on its own, so 'rest' often isn't enough to repair the damage.
Advanced Surgical Solution: Ankle Arthroscopy is used to both diagnose the extent of the damage and treat it. The goal is to restore a smooth joint surface. Depending on the size of the 'pothole,' this may involve cleaning the area (debridement), stimulating the bone to create new cartilage (microfracture), or transferring a plug of healthy cartilage to the damaged spot (OATS).
A 'clicking' or 'locking' ankle is a clear sign of a joint surface problem. Our team specializes in Arthroscopic Ankle Cartilage Repair to restore your mobility.
5. The 'Bump on the Inside': Accessory Navicular Syndrome
What it is: Not all gymnast ankle pain is in the joint. A common issue is a 'painful, tender 'bump' on the inner side of the foot, just above the arch'. This is often caused by an Accessory Navicular, an extra bone that an estimated 10-15% of people are born with. In young athletes, the strong pull of the posterior tibial tendon (which attaches near this extra bone) can cause inflammation and significant pain, making it difficult to wear shoes or perform certain skills.
When Conservative Care Fails: Immobilization in a boot or using orthotics can help calm the symptoms. But for a competitive gymnast, this often isn't a long-term solution, as the irritation returns with activity.
Advanced Surgical Solution: When the pain persists, Accessory Navicular Surgery (often a Kidner procedure) provides an excellent and permanent solution. This procedure involves removing the extra, problematic bone and, if necessary, securing the posterior tibial tendon to restore its proper function. The results for athletes are outstanding: one study showed that 94% of young athletes who had the surgery were able to return to their pre-surgery sports, with 76% reporting a complete elimination of pain.
That painful 'bump' isn't just a bruise. If it limits your activity, Accessory Navicular Surgery has an excellent track record for athletes.
When to See a Specialist: Moving Beyond 'Rest and Ice'
It's time to see an orthopaedic specialist if you or your gymnast experiences:
- Pain that causes you to modify or avoid a skill (e.g., changing a landing, avoiding a tumbling pass).
- Pain that is 'stabbing,' 'pinching,' or 'clicking,' rather than a dull muscular ache.
- A recurring feeling of instability or 'giving way,' even if it doesn't hurt.
- Pain that persists for more than two weeks, even after rest.
- Pain that prevents you from progressing in your sport.
Your Surgical Options: What 'Minimally Invasive' Means for Your Career
The word 'surgery' can be frightening for an athlete. But for these conditions, 'minimally invasive' procedures like arthroscopy and endoscopy are career-preserving.
By using small incisions and advanced camera technology, these procedures allow a surgeon to precisely target the problem—whether it's removing a bone spur, repairing a ligament, or smoothing cartilage—with minimal disruption to the healthy tissue around it. This means less 'surgical morbidity,' a faster recovery, and a more focused rehabilitation.
The goal of surgery for a gymnast is not just to be 'pain-free.' It is to be stable, strong, and confident in your landings. These advanced procedures are designed to restore the structural integrity of your ankle so you can return to the sport you love, safely and at your full potential.
Conclusion: Choose a Specialist Who Understands the Sport
As a gymnast, you are not a typical patient. Your body is a high-performance instrument, and your ankle is one of its most critical components. You need a surgeon who understands the unique demands of your sport and specializes in the advanced techniques required to treat it.
Dr. Victor Prisk is a board-certified orthopaedic surgeon with sub-specialty fellowship training in treating complex conditions of the foot and ankle. With a special focus on sports and dance medicine for high-performance athletes and specific expertise in arthroscopy around the ankle, including hindfoot endoscopy, he is uniquely qualified to diagnose and treat the full range of gymnast-related ankle injuries. AND… He is an All-American Gymnast from Michigan State University.
Don't let a treatable ankle injury limit your potential. If you are in the Pittsburgh or Monroeville area, schedule a consultation with Dr. Prisk for a definitive diagnosis and a plan to get you back to the mat.
Take the First Step Back to Your Sport
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🩺 Frequently Asked Questions About Gymnast Ankle Injuries
Q: I’m a gymnast. Isn't ankle pain just part of the sport?
A: While general muscle soreness from training is normal, sharp, stabbing, or pinching pain is not. Persistent pain, or feelings of 'crunching,' 'clicking,' or 'giving way,' is a warning sign of a structural problem. Accepting this as 'part of the sport' can lead to long-term joint damage, limit your performance, and even shorten your career.
Q: When should I see a doctor for my ankle pain?
A: It's time to see an orthopaedic specialist if you experience:
- Pain that makes you change or avoid a skill (like a landing or tumbling pass).
- Sharp, 'pinching,' or 'clicking' pain (not just a dull ache).
- A recurring feeling that your ankle is 'giving way' or unstable, even if it doesn't hurt.
- Pain that lasts for more than two weeks, even with rest.
- Any pain that stops you from progressing in your training.
Q: My ankle constantly 'rolls' or feels weak and wobbly. What could this be?
A: This is the classic sign of Chronic Ankle Instability (CAI). It often happens after an ankle sprain where the ligaments healed too loose. For a gymnast, this is dangerous as it makes landings unpredictable. When physical therapy isn't enough to stabilize the joint, a procedure to repair and tighten the ligaments may be the best solution.
Q: Why do I feel a sharp 'pinch' in the front of my ankle when I land?
A: This is likely Anterior Ankle Impingement, sometimes called a 'crunched ankle.' It's often caused by repetitive landing, which can lead to inflammation, scar tissue, or even bone spurs in the front of the joint. When stretching doesn't help, a minimally invasive procedure called ankle arthroscopy can be used to 'clean out' the joint and remove the blockage.
Q: What is the deep, aching pain I feel in the back of my ankle when I point my toes?
A: This is a common complaint for gymnasts and is characteristic of Posterior Ankle Impingement. It is often caused by a small, extra bone called an Os Trigonum that gets 'pinched' in the back of the ankle during the extreme toe-point. This can be treated with a specialized, minimally invasive procedure (hindfoot endoscopy) to remove the problematic bone.
Q: My ankle 'clicks,' 'locks,' or has a deep, persistent ache. What does that mean?
A: 'Clicking' or 'locking' sensations often point to a problem with the joint surface itself, such as an Osteochondral Lesion (OCD). This is like a 'pothole' in the smooth cartilage of the joint, often caused by repetitive stress or a previous sprain. Ankle arthroscopy can be used to diagnose the damage and repair the joint surface.
Q: Does needing ankle surgery mean my gymnastics career is over?
A: Absolutely not. In fact, for these types of structural problems, surgery is often career-preserving. Modern procedures like arthroscopy and endoscopy are 'minimally invasive,' using small incisions and a camera. This allows the surgeon to precisely fix the problem (like removing a bone spur or repairing a ligament) with less damage to surrounding tissue, leading to a faster, more focused recovery. The goal is to restore stability and get you back to the mat, stronger and more confident.
Q: Why should I see a specialist like Dr. Prisk for my ankle injury?
A: Gymnasts are high-performance athletes with unique demands. You need a surgeon who understands the sport. Dr. Prisk is a board-certified orthopaedic surgeon with sub-specialty fellowship training in complex foot and ankle conditions. He has a special focus on sports and dance medicine and specific expertise in the minimally invasive procedures described here, including hindfoot endoscopy for posterior impingement.
