Delayed diagnosis of posterior ankle impingement in pediatric and adolescent patients: does radiology play a role?

Associations between clinical and imaging findings in posterior ankle impingement syndrome: a systematic review

“…The literature search identified three studies that compared os trigonum prevalence on imaging between patients with clinically diagnosed PAIS and patients with symptomatic, non-PAIS ankles (40)(41)(42). Zwiers et al (40) reported os trigonum prevalence on computed tomography in a group of patients referred to a medical center for various foot and ankle symptoms.…”

“…Prevalence of os trigonum was 46.4% in patients with posterior impingement complaints, and 30.3% in those without (40). Kushare et al (42) reported a prevalence of os trigonum of 47% on magnetic resonance imaging (MRI) in a group of pediatric patients diagnosed with PAIS, compared to 5% in an age-matched control group. The control group were symptomatic patients who underwent MRI for acute ankle presentations that were deemed atypical for PAIS.…”

“…This has been similarly described in the posterior ankle (36,37). Many foot and ankle imaging studies analyze only symptomatic cases (5,14,20,24), others only asymptomatic (36–38), and some employ either cohort or case-control designs to compare between symptom status (21,39–42). A significant limitation of only analyzing symptomatic cases is the inability to determine the effect of activity exposure on imaging results.…”

Posterior ankle impingement disguised as peroneal tendon subluxation in young athletes – a case report

“…2,4 The diagnosis of PAIS is primarily based on an accurate history and clinical examination 2,4 which was the basis of diagnosis in our case series. This diagnosis can be missed in the pediatric population 4,5 and was supplemented by radiographic imaging confirming the diagnosis. 5 Even though it is very well described in adult literature, there is minimal literature on pediatric peroneal tendon subluxation.…”

“…This diagnosis can be missed in the pediatric population 4,5 and was supplemented by radiographic imaging confirming the diagnosis. 5 Even though it is very well described in adult literature, there is minimal literature on pediatric peroneal tendon subluxation. 1,6e10 Subluxation of the peroneus brevis and longus tendon from the superior peroneal retinaculum is typically caused by a traumatic mechanism and cast treatment can be used for 4e6 weeks.…”