Posterior Impingement

Posterior impingement is a clinical disorder manifested by pain at the posterior aspect of the ankle in plantarflexion [79]. This may be a result of acute injury or chronic repetitive stress, and is common in ballet dancers [79]. An os trigonum is present in about two of three cases (Fig. 36) [80]. Common MRI findings in posterior ankle impingement include increased T2 signal intensity posterior to

Posterior Impingement Ankle Mri
Fig. 40. Sagittal FSE image demonstrates the sinus tarsi, with normal interosseous talocalca-neal ligament (arrow).
Cervical Ligament Subtalar Joint
Fig. 41. Sinus tarsi with normal cervical ligament (arrow).

the subtalar joint from synovitis, tenosynovitis of the FHL tendon sheath, and thickening of the posterior capsule of the ankle joint (Fig. 34) [81]. Nonoperative treatment is effective in most patients [80]. In patients refractory to conservative therapy, surgical excision of the os trigonum, and debridement of the synovitis and FHL tendon sheath is usually effective in relieving symptoms [80].

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