To highlight different factors that can contribute to the development of posterior ankle impingement syndrome.

Posterior ankle impingement syndrome defined as symptomatic mechanical limitation of full-range plantar flexion of the ankle joint, which occurs due to repetitive plantar flexion. It is classically described in ballet dancers. Several predisposing anatomical factors can contribute to its occurance, which can be divided into osseus and soft-tissue causes. Secondary local soft-tissue inflammatory changes will ensue and result in more space-occupation of the posterior ankle i.e. fibrosis, bursa…etc., which consecuently makes further mechanical restriction that aggravates patient symptoms “vicious cycle” (Fig. 1).

Selected interseting cases for patients complained of posterior ankle pain upon ankle plantar flexion with limitation of the full-range movement. Imaging modalities include ankle MRI- and CT-scans. Several presented osseus cases are Stieda`s process, Os trigonum, Haglund`s deformity and tibial osteophyte formation, though combined cases can be seen as well (Fig. 2). On the other hand, (Fig. 3) shows different soft-tissue cases including tenosynovitis of the flexor hallucis longus tendon, vascular tortuosity, thickened intermaleolar ligament and synovitis (1,2).

Posterior ankle impingement syndrome is a clinical entity related to limited anatomical space and encompases variable osseus and soft-tissue causes, in which imaging plays a paramout importance to reach the appropriate diagnosis. Early diagnosis will prevent the vicious cycle of changes that will worsen patient complaint.

1. Cerezal L, Abascal F, Canga A, Pereda T, García-Valtuille R, Pérez-Carro L, Cruz A. MR imaging of ankle impingement syndromes. AJR Am J Roentgenol. 2003 Aug;181(2):551-9. 2.Peace KA, Hillier JC, Hulme A, Healy JC.MRI features of posterior ankle impingement syndrome in ballet dancers: a review of 25 cases.Clin Radiol. 2004 Nov;59(11):1025-33.

Omar M. Albtoush Department of Diagnostic and Interventional Radiology, Eberhard Karls Universität Tübingen, 72076 Tuebingen, Germany.