Houston Methodist. Leading Medicine

Ankle News

Posterior Ankle Impingement Syndrome (PAIS): Profile of a Painful Ankle

In this article Dr. J. Maquirrian reviews a condition called posterior ankle impingement syndrome (PAIS). The patient with this problem reports pain in the back (posterior) part of the ankle. It occurs most often when the toes are pointed all the way down. This position is called ankle plantar flexion.

Various causes of PAIS are reviewed along with ankle anatomy. Downhill runners, kickers, and dancers are affected most often. Fractures, athletic injuries, and repetitive stress are often part of the picture.

Doctors make the diagnosis based on an exam. Patient report of symptoms and X-rays, MRIs, or other imaging studies is also used. The author gives a flow sheet for treatment starting with rest. Ice, antiinflammatory drugs, and avoiding forced plantar flexion are often used.

Patients may be given a physical therapy program of strengthening exercises. Surgery is an option when conservative treatment fails. The author reviews various operative methods, depending on the underlying cause of the problem.


Javier Maquirriain, MD, PhD. Posterior Ankle Impingement Syndrome. In Journal of the American Academy of Orthopaedic Surgeons. October 2005. Vol. 13. No. 6. Pp. 365-371.

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*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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