Posterior Ankle Impingement

Abstract

Posterior ankle impingement is a common cause of chronic ankle pain and results from compression of bony or soft tissue structures during ankle plantar flexion. Bony impingement is most commonly related to an os trigonum or prominent trigonal process. Posteromedial soft tissue impingement generally arises from an inversion injury, with compression of the posterior tibiotalar ligament between the medial malleolus and talus. Posterolateral soft tissue impingement is caused by an accessory ligament, the posterior intermalleolar ligament, which spans the posterior ankle between the posterior tibiofibular and posterior talofibular ligaments. Finally, anomalous muscles have also been described as a cause of posterior impingement.

Ankle impingement syndromes: an imaging review

“…This can lead to damage to the PTTL and associated synovitis, which can partially encase the posterior tibialis tendon (PTT) (40% of cases), the flexor hallucis longus tendon (16% of cases) or the flexor digitorum longus tendon (8% of cases). 45 It was first described by Liu and Mirzayan 46 in 1993 and remains one of the least common ankle impingement syndromes. 17 Commonly, the patient presents with pain over the posteromedial aspect of the ankle with both passive and active movement.…”

Arthroscopic Management of Posteromedial Ankle Impingement

“…The subsequent fibrosis and thickening of the injured posterior tibiotalar ligament and posteromedial capsule cause impingement between the medial wall of the talus and posterior margin of the medial malleolus, resulting in formation of collagenous and fibrous meniscoid lesions and synovitis at the posteromedial ankle. 6,[8][9][10][11][12] The ankle usually shows deep soft-tissue induration and localized tenderness; pain is evocable by palpating the medial retromalleolar area while moving the ankle. 2 Posteromedial tenderness on inversion with the ankle in plantar flexion is an important sign to differentiate the ankle pain originating from the tibialis posterior tendon.…”

Posterior ankle impingement in athletes: Pathogenesis, imaging features and differential diagnoses

“…Posterior ankle impingement is a clinical diagnosis which may complicate an acute traumatic hyper-plantar flexion event or may relate to repetitive low-grade trauma associated with hyper-plantar flexion, e.g., in female dancers ('en pointe' or the 'demi-pointe'), downhill running, football players, javelin throwers and gymnasts [1][2][3]. The forceful plantar flexion that occurs during these activities produces compression at the posterior aspect of the ankle joint and can put extreme pressure on the anatomic structures normally present between the calcaneus and the posterior part of the distal tibia.…”