Posterior Impingement & Arthroscopy

Posterior ankle impingement syndrome (PAIS) is a common source of chronic ankle pain, particularly in athletes who perform repetitive plantarflexion movements, such as ballet dancers, soccer players, and gymnasts.

One of the key anatomical contributors to this condition is the os trigonum, an accessory bone located behind the ankle joint. Dr Daniel Meyerkort, an experienced orthopaedic surgeon at Perth Orthopaedic & Sports Medicine Centre, offers specialised assessment and treatment options, including both non-surgical and surgical interventions tailored to the patient’s individual needs.

Understanding Posterior Ankle Impingement and Os Trigonum Syndrome

Posterior ankle impingement occurs when soft tissues or bony structures at the back of the ankle become compressed during forced plantarflexion (pointing the toes downward). The os trigonum, present in approximately 10–15% of the population, is a small bone that may remain unfused behind the talus and can become symptomatic following trauma, overuse, or repetitive strain.

In athletes or individuals with a history of ankle sprains, the os trigonum may become entrapped between the tibia and calcaneus, leading to inflammation and pain. The resulting condition is often referred to as os trigonum syndrome.

Symptoms of Posterior Ankle Impingement

Patients typically present with:

  • Pain at the back of the ankle, worsened by plantarflexion

  • Swelling around the posterior ankle

  • Tenderness on deep palpation behind the ankle joint

  • Limited range of motion, especially during sports

  • Pain while running, jumping, or pointing the toes

These symptoms may develop gradually or acutely following an injury. Accurate diagnosis is essential to determine whether the pain is due to os trigonum syndrome or another cause such as Achilles tendinopathy, flexor hallucis longus (FHL) tendinitis, or posterior ankle ligament damage.

Diagnosis

Dr Daniel Meyerkort utilises a combination of clinical examination and imaging to confirm the diagnosis:

  • X-rays to identify the presence of an os trigonum or bony fragments

  • MRI to assess soft tissue inflammation or synovitis

  • CT scans for detailed bony anatomy when planning surgery

  • Ultrasound for dynamic assessment and guided injections

Non-Surgical Management

For many patients, especially in the early stages, conservative treatment is effective. Dr Meyerkort offers a comprehensive non-operative management plan including:

1. Activity Modification

Avoiding or modifying activities that exacerbate the pain is the first step. Athletes may benefit from sport-specific rest or technique adjustments.

2. Physiotherapy

A tailored rehabilitation program with a focus on:

  • Posterior ankle joint mobilisation

  • Calf muscle stretching and strengthening

  • Proprioception and balance training

  • Load management

Working closely with experienced physiotherapists in Perth and regional Western Australia, Dr Meyerkort ensures continuity of care even for rural patients through Telehealth consultations.

3. Anti-inflammatory Medications

Short courses of NSAIDs may help manage inflammation.

4. Corticosteroid Injection

Ultrasound-guided steroid injections around the os trigonum or FHL tendon sheath can provide diagnostic clarity and temporary symptom relief.

Many patients respond well to non-surgical treatment, particularly if the symptoms are mild and managed early. However, if pain persists beyond 3–6 months despite these measures, surgical intervention may be indicated.

Surgical Management

When conservative methods fail, surgical treatment can offer long-term relief and restore athletic function. The gold standard for symptomatic os trigonum and posterior impingement is posterior ankle arthroscopy, a minimally invasive procedure performed by Dr Daniel Meyerkort at Perth Orthopaedic & Sports Medicine.

Posterior Ankle Arthroscopy

This technique involves two small incisions at the back of the ankle through which a camera and surgical instruments are inserted. Dr Meyerkort performs:

  • Excision of the os trigonum

  • Debridement of inflamed synovium

  • Release of the FHL tendon if impinged

Benefits of Posterior Ankle Arthroscopy

Posterior ankle arthroscopy offers several advantages compared to open surgery:

  • Minimally invasive: Smaller incisions mean less tissue disruption

  • Faster recovery: Most patients return to sport within 8–12 weeks

  • Lower complication rate: Reduced risk of wound issues and infection

  • Improved accuracy: High-definition camera allows direct visualisation of pathology

  • Early weight bearing: Patients can often mobilise in a boot within a few days

Dr Meyerkort uses this technique routinely, particularly for professional and semi-professional athletes who require a quicker return to competition.

Risks of Surgery

Although generally safe, all surgeries carry some risk. Risks associated with posterior ankle arthroscopy include:

  • Infection

  • Injury to nearby nerves or tendons, particularly the tibial nerve and FHL

  • Incomplete symptom relief

  • Scar tissue formation or stiffness

  • Recurrence of symptoms if rehabilitation is not followed properly

Dr Meyerkort ensures that each patient is thoroughly informed of these risks and benefits before proceeding with surgery.

Post-Operative Recovery & Rehabilitation

Post-surgery, patients follow a structured rehab protocol designed by Dr Meyerkort’s team in collaboration with physiotherapists:

  • Week 1–2: Rest, ice, compression, and elevation. Protected weight bearing in a boot.

  • Week 3–6: Gradual increase in movement and strength with supervised exercises.

  • Week 6–12: Return to sport-specific training and functional activities.

  • Week 12+: Full return to sport if strength, range of motion, and confidence are regained.

Athletes typically return to full competition within 3 months, depending on the level of sport and adherence to rehabilitation.

Why Choose Dr Daniel Meyerkort at Perth Orthopaedic & Sports Medicine?

Dr Daniel Meyerkort is a fellowship-trained orthopaedic surgeon specialising sports ankle surgery. Based in West Perth, he provides expert diagnosis and treatment of posterior ankle impingement and os trigonum syndrome. His modern, minimally invasive surgical approach and commitment to evidence-based care ensures patients receive high-quality outcomes.

Key benefits of choosing Dr Meyerkort include:

  • Access to posterior ankle arthroscopy expertise

  • Integrated care with on-site physiotherapy and radiology

  • Telehealth services for regional WA patients

  • Extensive experience treating elite and recreational athletes

Personalised Orthopaedic Care in Perth

If you are experiencing chronic posterior ankle pain or suspect os trigonum syndrome, don’t delay treatment. Early diagnosis and tailored management can prevent long-term damage and help you get back to your active lifestyle.

Contact Perth Orthopaedic & Sports Medicine Centre to book an appointment with Dr Daniel Meyerkort in West Perth or via Telehealth.