38 y/o female with posterior impingement syndrome. She has experienced pain in the posterior aspect of the ankle joint, increasingly so over the last few years. Pain is especially worst with plantarflexion and certain shoes (high heels). Diagnostic ankle injection with local anesthetic improved her symptoms about 60-70%. Diagnostic subtalar joint injection about 30-40%. Steroid injection in both joints completely alleviated symptoms for a few months.
MRI was obtained showing synovitis and spurring at the back of the ankl and subtalar joints with some synovitis along the Flexor Hallucis Longus tendon (big toe flexor tendon). Posterior arthroscopy was performed and synovitis was seen throughout, especially at the posterior aspect of the subtalar and ankle joints. The FHL tendon was intact with mild synovitis. Pain has since resolved.
Posterior impingement syndrome is not uncommon and seen frequently in ballet dancers, soccer players, and distance runners. In non-athletes it is seen in individuals who wear high heels routinely for a number of years or those who are active performing activities that necessitate sudden acceleration, jumping, and extreme plantarflexion. The impingement results from compression of structures behind the ankle and subtalar joints during plantarflexion, causing pain from entrapment of various soft tissues like tendons, development of spurs around these joints, inflammation, or scarring.
If you, a loved one, or a friend is experiencing these conditions, please contact us to prevent any further complications.
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