Fact-sheet: Posteromedial impingement of ankle


Updated on 11/14/2024 at 10:45 AM

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Definition

Posteromedial ankle impingement is generally secondary to a plantarflexion, inversion, and internal rotation injury, causing compression and injury to the posterior tibiotalar ligament and the posteromedial aspect of the ankle joint capsule, resulting in synovial thickening, synovitis, and potentially injury to the adjacent flexor tendons (posterior tibial)

Clinical features

Posteromedial ankle pain with active and passive range of motion, worsened by supination and plantarflexion

Radiography

Soft tissue thickening over the posteromedial aspect of the ankle

Ultrasound

Hypoechoic thickening, partial or complete tear of the posterior tibiotalar ligament, with Doppler hyperemia

Search for associated tenosynovitis of the flexor tendons

CT

CT arthrography:

  • tear of the posterior tibiotalar ligament
  • osteosclerosis and/or microgeodic changes on both sides of the medial tibiotalar joint space

MRI

Partial or complete tear of the superficial and deep bundles of the posterior tibiotalar ligament

Possible subchondral edema and microcystic changes on either side of the medial tibiotalar joint space

Search for tenosynovitis or tendinopathy of the tendons of the medial ankle compartment, particularly the posterior tibialis

Contrast enhancement after injection