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DOI: 10.1055/s-2008-1078703
Posterior Impingement Syndromes of the Ankle
Publikationsverlauf
Publikationsdatum:
28. Mai 2008 (online)
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ABSTRACT
Acute, or repetitive, compression of the posterior structures of the ankle may lead to posterior ankle impingement (PAI) syndrome, posteromedial ankle impingement (PoMI) syndrome, or Haglund's syndrome. The etiology of each of these conditions is quite different. Variations in posterior ankle osseous and soft tissue anatomy contribute to the etiology of PAI and Haglund's syndromes. The presence of an os trigonum or Stieda process is classically associated with PAI syndrome, whereas a prominent posterosuperior tubercle of the os calcis or Haglund's deformity is the osseous predisposing factor in Haglund's syndrome. PoMI has no defined predisposing anatomical variants but typically follows an inversion-supination injury of the ankle joint. This article discusses the biomechanics, clinical features, imaging, and management of each of these conditions. Magnetic resonance imaging (MRI) provides the optimal tool in posterior ankle assessment, and this review focuses on the MRI findings of each of the conditions just listed.
KEYWORDS
MR imaging - ankle - impingement - sport - arthroscopy
REFERENCES
- 1 Marotta J J, Micheli L J. Os trigonum impingement in dancers. Am J Sports Med. 1992; 20 533-536
- 2 Karasick D, Schweitzer M E. The os trigonum syndrome: imaging features. AJR Am J Roentgenol. 1996; 166 125-129
- 3 Brodsky A E, Khalil M A. Talar compression syndrome. Am J Sports Med. 1986; 14 472-476
- 4 Peace K A, Hillier J C, Hulme A, Healy J C. MRI features of posterior ankle impingement syndrome in ballet dancers: a review of 25 cases. Clin Radiol. 2004; 59 1025-1033
- 5 Van Dijk C N. Hindfoot endoscopy. Foot Ankle Clin. 2006; 11 391-414
- 6 Hedrick M R, McBryde A M. Posterior ankle impingement. Foot Ankle. 1994; 15 2-8
- 7 Van Dijk C N, Lim L SL, Poortman A et al.. Degenerative joint disease in female ballet dancers. Am J Sports Med. 1995; 23 295-300
- 8 Robinson P, Bollen S R. Posterior ankle impingement in professional soccer players: effectiveness of sonographically guided therapy. AJR Am J Roentgenol. 2006; 187 W53-W58
- 9 Hardaker Jr W T. Foot and ankle injuries in classical ballet dancers. Orthop Clin North Am. 1989; 20 621-627
- 10 Hamilton W G, Geppert M J, Thompson F M. Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment. J Bone Joint Surg Am. 1996; 78 1491-1500
- 11 Wakeley C J, Watt I, Johnson D P. The value of MR imaging in the diagnosis of the os trigonum syndrome. Skeletol Radiol. 1996; 25 133-136
- 12 Bureau N J, Cardinal E, Hobden R, Aubin B. Posterior ankle impingement syndrome: MR imaging findings in seven patients. Radiology. 2000; 215 497-503
- 13 Hamilton W G. Stenosing tenosynovitis of the flexor hallucis longus tendon and posterior impingement upon the os trigonum in ballet dancers. Foot Ankle. 1982; 3 74-80
- 14 Rosenburg Z S, Cheung Y Y, Beltran J, Sheskier S, Leong M, Jahss M. Posterior intermalleolar ligament of the ankle: normal anatomy and MR imaging features. AJR Am J Roentgenol. 1995; 165(2) 387-390
- 15 Fiorella D, Helms C A, Nunley II J A. The MR imaging features of the posterior intermalleolar ligament in patients with posterior impingement syndrome of the ankle. Skeletal Radiol. 1999; 28 573-576
- 16 Robinson P. Impingement syndromes of the ankle. Eur Radiol. 2007; 17(12) 3056-3065
- 17 Mitchell M J, Bielecki D, Bergman A G, Kursunoglu-Brahme S, Sartoris D J, Resnick D. Localization of specific joint causing hindfoot pain: value of injecting local anesthetics into individual joints during arthrography. AJR Am J Roentgenol. 1995; 164 1473-1476
- 18 Abramowitz Y, Wollstein R, Barzilay Y et al.. Outcome of resection of a symptomatic os trigonum. J Bone Joint Surg Am. 2003; 85 1051-1057
- 19 Ferkel R D, Small H N, Gittins J E. Complications in foot and ankle arthroscopy. Clin Orthop Relat Res. 2001; 391 89-104
- 20 Meislin R J, Rose D J, Parisien J S, Springer S. Arthroscopic treatment of synovial impingement of the ankle. Am J Sports Med. 1993; 21 186-189
- 21 Paterson R S, Brown N J. The posteromedial impingement lesion of the ankle. A series of six cases. Am J Sports Med. 2001; 29 550-557
- 22 Koulouris G, Connell D, Schneider T, Edwards W. Posterior tibiotalar ligament injury resulting in posteromedial impingement. Foot Ankle Int. 2003; 24 575-583
- 23 Messiou C, Robinson P, O'Connor P J, Grainger A. Subacute posteromedial impingement of the ankle in athletes. Skeletal Radiol. 2006; 35 88-94
- 24 Haglund P. Beitrag zur Klinik der Achillessehne. Z Orthop Chir. 1927; 49 49-58
- 25 Pavlov H, Heneghan M A, Hersh A, Goldman A B, Vigorita V. Haglund's syndrome: initial and differential diagnosis of posterior heel pain. Radiology. 1982; 144 83-87
- 26 Ly J Q, Bui-Mansfield L T. Anatomy of and abnormalities associated with Kager's fat pad. AJR Am J Roentgenol. 2004; 182 147-154
- 27 Schepsis A A, Jones H, Haas A L. Achilles tendon disorders in athletes. Am J Sports Med. 2002; 30 287-305
- 28 Jerosch J, Schunck J, Sokkar S H. Endoscopic calcaneoplasty (ECP) as a surgical treatment of Haglund's syndrome. Knee Surg Sports Traumatol Arthrosc. 2007; 15 927-934
- 29 Leitze Z, Sella E J, Aversa J M. Endoscopic decompression of the retrocalcaneal space. J Bone Joint Surg Am. 2003; 85 1488-1496
- 30 Calder J D, Saxby T S. Surgical treatment of insertional Achilles tendinosis. Foot Ankle Int. 2003; 24 119-121
Jeremiah C HealyM.A. M.B. B.Chir.
Department of Radiology, Chelsea and Westminster Hospital
369 Fulham Road, London, SW10 9NH, UK
eMail: j.healy@ic.ac.uk