Fact-sheet: Posterior ankle impingement syndrome


Updated on 04/30/2026 at 10:22 AM

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Definition

Compression of the posterior aspect of the talus or the surrounding soft tissues secondary to impingement during forced plantar flexion of the ankle between the posteroinferior aspect of the tibia and the superior aspect of the calcaneus

Clinical features

Risk factors: ballet, soccer, volleyball, basketball.
Chronic mechanical pain of the posterolateral ankle worsened by plantar flexion

Radiography

May demonstrate:

  • a Stieda process
  • an Os trigonum
  • infiltration of Kager's fat triangle

CT

Fracture, fragmentation, or Non union of the Os trigonum or of the lateral tubercle of the talus (Shepherd's fracture)

MRI

Reference examination: assessment of cancellous bone and soft tissues

  • Marrow edema of the lateral tubercle, especially if it is elongated (Stieda process)
  • Contusion- or fracture-related edema of the Os trigonum
  • Fluid signal within the synchondrosis with the Os trigonum.
  • Cystic lesions and edematous changes around the synchondrosis
  • Bone fragmentation and osteochondromatosis
  • Tenosynovitis of the flexor hallucis longus
  • Talocrural and posterior subtalar joint effusion
  • Meniscoid thickening of the posterior intermalleolar ligament
  • Thickening and T2 hyperintensity of the posterior talofibular ligament
  • Focal capsular thickening of the distal tibiofibular joint

Nuclear medicine

Increased uptake at the posterior aspect of the talus or of the Os trigonum.

Does not assess soft tissues.

Management

1: Conservative medical treatment

2: if treatment fails, consider excision of the bone fragments and/or release of the flexor hallucis longus tendon