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Footballer's Ankle. Dancer's Heel.

Anterior, Posterior, and Subtalar Ankle Impingement

Impingement means something is getting pinched in your ankle — bone against bone, or inflamed tissue caught between them — at the extremes of the exact motion your sport demands. Where it pinches determines what it is, and what fixes it.

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By Victor R. Prisk, MD, FAAOS — Board-Certified Orthopaedic Surgeon, Foot & Ankle Fellowship (HSS) · Last updated August 2026

At a Glance

Best for
Pinching at motion extremes
Anterior
Spurs from cutting & landing
Posterior
Os trigonum / FHL — dancers
Approach
Arthroscopic & endoscopic
Surgery
Outpatient, small portals
Dancers
Demi-pointe ~wk 4, pointe ~wk 6

The Front

Anterior Impingement: The Pinch Up Front

The "stinging pinch" at the front of the ankle when you squat, lunge, land, or sprint. Years of cutting and landing build bone spurs and scar tissue along the front of the joint — the classic "footballer's ankle," equally at home in soccer players, gymnasts, and lifters.

When conservative care fails, ankle arthroscopy removes the spurs and scar tissue through 3 mm portals. That's precisely the procedure that returned Freddie Freeman to baseball — I broke down his surgery here.

Which One Is Yours?

Location + Position

Front of ankle, deep squat or landing → anterior.

Behind the ankle, on pointe or kicking → posterior.

Below the ankle, uneven ground → subtalar.

The Back

Posterior Impingement: The Dancer's Heel

A deep, aching pain in the back of the ankle, triggered by full pointe, tendu, jumping, or kicking. Up to one in three people has an extra bone behind the talus (the os trigonum), and in dancers it becomes the "nutcracker": caught and crushed between tibia and heel bone at maximal plantarflexion, often inflaming the FHL tendon — the "dancer's tendon" — alongside it.

This is the heart of my dance medicine practice. Using small posteromedial and posterolateral portals and a 2.4 mm arthroscope, I perform posterior endoscopic os trigonum excision combined with FHL tenolysis — removing the bony impinger and freeing the tendon in one minimally invasive procedure. I'm one of the only physicians in Pittsburgh performing this endoscopically. Dancers on my published protocol typically return to demi-pointe around week 4 and full pointe around week 6.

Deep dives: the Nutcracker syndrome and FHL injuries in ballet dancers.

The Workup

Prove the Pinch Before Treating It

Location plus provocation: where it hurts, and which position reproduces it. Then the right test:

X-ray

Spurs at the front; os trigonum at the back.

MRI

Tendon and soft-tissue inflammation — FHL, capsule, synovium.

Weight-bearing CT

In-office standing CT when bony detail matters.

Guided injections

If numbing the suspected pinch point erases your pain, we have our answer.

Most impingement starts with conservative care: activity and technique modification — for dancers, reviewed by someone who has actually danced — therapy with our on-site P.O.W.ER team, and targeted injections. Surgery is for the pinch that won't quit.

Why P.O.W.

Treated by Someone Who's Stood in Class

I'm a former NCAA All-American gymnast and professional dancer, a member of the International Association for Dance Medicine & Science, and I care for dancers from Pittsburgh's professional ballet companies.

  • One of the only physicians in Pittsburgh performing endoscopic os trigonum excision + FHL tenolysis
  • Independent practice — operating privileges at both AHN and UPMC facilities
  • Return-to-dance milestones: demi-pointe, pointe, jumps, repertoire

Hurt at Work?

We treat workers' compensation cases and provide independent medical examinations.

The Comeback

Recovery

  1. Same-day surgery

    Small-incision arthroscopic or endoscopic work; home within hours.

  2. Early motion

    Protected mobility and swelling control; therapy begins.

  3. Sport-specific milestones

    Dancers: demi-pointe around week 4, full pointe around week 6 on my protocol.

  4. Full return

    Cutting, jumping, and repertoire — benchmarked, in writing.

Questions Patients Ask

Impingement, Answered

What does ankle impingement feel like?
A pinch or block at the extreme of motion: front of the ankle in deep squats and landings (anterior), or deep behind the ankle on pointe, in tendu, or when kicking (posterior). Rest often feels fine — the position is the trigger.
What is an os trigonum, and do I need it?
An extra bone behind the talus that up to a third of people are born with. You don't need it — most owners never know it's there. It only matters when extreme plantarflexion (ballet, gymnastics, kicking sports) crushes it against surrounding bone.
Can dancers get back on pointe after os trigonum surgery?
Yes. With endoscopic excision and a structured rehab protocol, my dancers typically reach demi-pointe around week 4 and full pointe around week 6.
Does impingement always need surgery?
No. Technique changes, therapy, and targeted injections resolve many cases. Surgery is for confirmed impingement that persists despite proper conservative care.
Is this covered by insurance?
We are in-network with Highmark/BCBS, UPMC, Aetna, Cigna, United, most Medicare plans, and others. Call the office to confirm your specific plan.

Prisk Orthopaedics and Wellness

Stop Dancing (or Playing) Around the Pinch

Anterior, posterior, or subtalar — confirmed, then fixed, by a surgeon who knows the positions that cause it.

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2490 Mosside Blvd, Monroeville, PA 15146  ·  Serving Pittsburgh, Monroeville, Murrysville, Plum, Penn Hills & Greensburg  ·  Insurance accepted