Posterior Ankle Impingement

Abstract

The posterior ankle impingement syndrome is a common cause of ankle pain in football players. It is characterised by posterior ankle pain on forced plantar flexion movements. Clinical investigation reveals pain on palpation along the posterolateral and/or posteromedial ankle joint line. There is recognisable pain on forced plantar flexion which can be limited as compared to the contralateral side. An infiltration with 1 cc anaesthetic posterolateral over the pain spot that temporarily reduces the pain is an additional proof for the diagnosis posterior impingement pain. In patients with posterior impingement pain, the plain X-rays can be negative and are therefore insufficient. An additional straight lateral (posterior impingement) view is required for visualisation of posterior bone structures, i.e. an os trigonum or an elongated posterior talar process that can cause the posterior impingement pain. The effectiveness of conservative treatment has not yet been well documented. After conservative treatment fails, an arthroscopic intervention is the treatment of choice for professional football players. Posterior ankle arthroscopic release of the retinaculum of the flexor hallucis longus with reduction of the elongated posterior talar process or removal of the os trigonum or excision of loose bodies is known to be successful in football players, without signs of joint space narrowing. The majority of professional football players will return to their former level within 2 months after surgery.

Behind every kick of the ball there has to be a thought.

Dennis Bergkamp