Posterior ankle impingement (PAI) syndrome is one of the impingement syndromes involving the ankle.
On this page:
Epidemiology
It is usually a unilateral phenomenon. Bilateral posterior ankle impingement syndrome has been described but is rare 5. It is classically described in ballet dancers.
Clinical presentation
Patients usually present with a sharp pain at the back of the ankle upon plantar flexion. The pain might persist for some time after such a movement.
Pathology
Thought to occur from repetitive ankle plantar flexion leading to soft tissue compression, synovitis, capsulitis, and eventually scarring 6.
Predisposing anatomical factors include ref:
fracture involving lateral tubercle of the posterior process of the talus
prominent superior surface of calcaneal tuberosity
prominent downslope of the posterior tibial articular surface
any abnormal calcification/ossification posterior to the ankle
Radiographic features
MRI
may demonstrate posterolateral capsular thickening and synovitis involving an intact posterior talofibular ligament
there may be tenosynovitis involving the flexor hallucis longus
may show one or more of the predisposing anatomical factors
accompanying bone contusion may be present, involving the lateral tubercle of the posterior talar process
localized fluid and/or edema in the posterior joint recesses
MRI signal characteristics
T1: low signal in areas of bone bruising
T2/STIR: high signal posterior to ankle in areas of bone bruising
PD/PD fat saturated: high signal posterior to the ankle
Unable to process the form. Check for errors and try again.