Posterior Ankle Impingement Syndrome Clinical Features Are Not Associated With Imaging Findings in Elite Ballet Dancers and Athletes

Abstract

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EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Ankle/Foot

“…Tenosynovitis, rupture, and posterior ankle impingement are common eventual clinical conditions to be encountered. 12 With regard to the latter, os trigonum 13 may also be visualized with dynamic evaluation (Video 6, http:// links.lww.com/PHM/C191).…”

“…At the level of the ankle joint, careful scanning is mandatory to display the tendon running between the two posterior processes of talus. Tenosynovitis, rupture, and posterior ankle impingement are common eventual clinical conditions to be encountered 12 . With regard to the latter, os trigonum 13 may also be visualized with dynamic evaluation (Video 6, http://links.lww.com/PHM/C191).…”

Posterior Ankle Impingement: It’s Not Only About the Os Trigonum

“… 4 , 20 , 33 , 35 The high prevalence of os trigonum in imaging examinations also places it as potential incidental finindgs. 2 , 35 Conversely, ultrasonography provides the ability for dynamic testing (imaging structures during physical examination maneuvers) that can reproduce clinical symptoms, but visualization can be constrained by depth, definition, and the experience of the operator. 14 , 23 …”

“… 9 , 27 The physical examination finding of posterior impingement, and studies that demonstrate the bony trigonal impingement, focus attention on the removal of these bony structures as the single goal in the treatment. 2 , 30 , 37 The concomitant role of the flexor hallucis longus (FHL) tendon as an additional pain generator is described as a common associated finding, which is also treated by resection of the process. 15 , 30 However, recent literature have been pointing to various other anatomic structures that could be etiologies of PAIS.…”

“…Although the general reproduction of impingement pain can be clearly diagnosed preoperatively by physical examination, the specific structure(s) causing symptoms are not always evident. 2 , 3 Posterior ankle and hindfoot arthroscopy (PAHA) is an established approach to treat PAIS. 5 , 15 , 37 The increased magnification, field of view, and real-time dynamics that an arthroscope provides allows assessment of other anatomic structures as potential causes of impingement, in addition to Stieda impingement.…”