Posterior ankle impingement syndrome is a condition resulting from the entrapment of anatomical structures in the posterior ankle during end-range plantar flexion. It is particularly common among athletes and dancers due to repetitive stress in plantar-flexed positions. The syndrome can result from bony causes, such as os trigonum or an elongated posterolateral talar process, or from soft tissue causes, including hypertrophic ligaments or flexor hallucis longus pathologies. Diagnosis relies on a detailed clinical history, physical examination, imaging, and the posterior impingement test, often confirmed by lidocaine injection. While conservative treatments like rest, physical therapy, and injections may offer symptom relief, their effectiveness remains poorly documented. Arthroscopic or endoscopic surgery is currently considered the standard of care for refractory cases, offering lower complication rates and faster return to play compared to open surgery. Rehabilitation protocols vary depending on the surgical technique, but early mobilization is encouraged. Outcomes are generally favorable, particularly in chronic overuse cases, with high satisfaction and return-to-sport rates, especially in professional athletes. The choice of surgical technique and rehabilitation strategy must be individualized based on etiology, patient profile, and sport-specific demands.