Abstract
Posterior ankle impingement pain is caused by the compression of the posterior ankle bony and soft tissue structures during terminal flexion. The fibro-osseous tunnel along the talus and calcaneus is the potential entrapment site of the flexor hallucis longus tendon. MRI is the gold standard to evaluate the FHL tendinopathy, soft tissue inflammation, and bony edema at the os trigonum. Symptoms that are recalcitrant to conservative treatment and/or high-level athletes often require open versus arthroscopic surgical intervention. Potential complications following posterior arthroscopy include iatrogenic injury to the tibial nerve, sural nerve, and medial calcaneal nerve injury.
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Beals TC, Junko JT, Amendola A, Nickisch F, Saltzman CL. Minimally invasive distraction technique for prone posterior ankle and subtalar arthroscopy. Foot Ankle Int. 2010;31(4):316–9. https://doi.org/10.3113/fai.2010.0316.
Feiwell LA, Frey C. Anatomic study of arthroscopic portal sites of the ankle. Foot Ankle. 1993;14(3):142–7. https://doi.org/10.1177/107110079301400306.
Giannini S, Buda R, Mosca M, Parma A, Di Caprio F. Posterior ankle impingement. Foot Ankle Int. 2013;34(3):459–65. https://doi.org/10.1177/1071100713477609.
Hamilton WG. Stenosing tenosynovitis of the flexor hallucis longus tendon and posterior impingement upon the os trigonum in ballet dancers. Foot Ankle. 1982;3(2):74–80. https://doi.org/10.1177/107110078200300204.
Kelikian AS, Sarrafian SK, et al. Sarrafian’s anatomy of the foot and ankle. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.
Nickisch F, Barg A, Saltzman CL, Beals TC, Bonasia DE, Phisitkul P, et al. Postoperative complications of posterior ankle and hindfoot arthroscopy. J Bone Joint Surg Am. 2012;94(5):439–46. https://doi.org/10.2106/jbjs.K.00069.
Phisitkul P, Amendola A. False FHL: a normal variant posing risks in posterior hindfoot endoscopy. Arthroscopy. 2010;26(5):714–8. https://doi.org/10.1016/j.arthro.2009.07.026.
Phisitkul P, Tochigi Y, Saltzman CL, Amendola A. Arthroscopic visualization of the posterior subtalar joint in the prone position: a cadaver study. Arthroscopy. 2006;22(5):511–5. https://doi.org/10.1016/j.arthro.2005.12.034.
van Dijk CN, Scholten PE, Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy. 2000;16(8):871–6. https://doi.org/10.1053/jars.2000.19430.
van Dijk CN, Verhagen RA, Tol HJ. Technical note: resterilizable noninvasive ankle distraction device. Arthroscopy. 2001;17(3):E12. https://doi.org/10.1053/jars.2001.19453.
van Dijk CN, de Leeuw PA, Scholten PE. Hindfoot endoscopy for posterior ankle impingement. Surgical technique. J Bone Joint Surg Am. 2009;91(Suppl 2):287–98. https://doi.org/10.2106/jbjs.I.00445.
Vega J, Redó D, Savín G, et al. Anatomical variations of flexor hallucis longus tendon increase safety in hindfoot endoscopy. Knee Surg Sports Traumatol Arthrosc. 2017;25:1929–35. https://doi.org/10.1007/s00167-017-4465-2.
Vosseller JT, Dennis ER, Bronner S. Ankle injuries in dancers. J Am Acad Orthop Surg. 2019;27(16):582–9. https://doi.org/10.5435/jaaos-d-18-00596.
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Wei, B., Akoh, C.C., Murawski, C.D., Phisitkul, P. (2022). Posterior Impingement: FHL Tendinopathy. In: Arthroscopic Techniques and Anatomy of the Foot and Ankle. Springer, Cham. https://doi.org/10.1007/978-3-031-05190-6_14
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