Posterior ankle impingement: os trigonum syndrome.

摘要: Six types of ankle impingement are described in the literature, and each takes its name from location about joint. The 3 most common syndromes anterior impingement, anterolateral posterior impingement. Three other syndromes—anteromedial posteromedial syndesmotic impingement—are less well characterized literature. Posterior syndrome is by pain with forceful plantar flexion. Soft tissues, bony processes, unfused ossicles, or osseous fragments entrapped between tibial plafond superior calcaneus lead to symptoms. Structures implicated etiology include os trigonum, a prominent posterolateral process talus, fractures ossicle talar process, enlarged calcaneus, intermalleolar ligament, soft-tissue loose bodies, ganglia, calcified inflammatory tissue, low-lying flexor hallucis longus muscle belly, anomalous muscles. 1 Pathology trigonum–talar cause syndrome. 2 Os trigonum subset caused pathology at talus. seen athletes who engage flexion push-off maneuvers, such as jumping, downhill running, kicking. Clinical presentation may be either acute secondary trauma chronic result repetitive stress. Ballet dancers commonly afflicted, female ballerinas particularly susceptible, given extreme en pointe position. ossification center corner mineralizes ages 7 13 years. Usually, this fuses talus form Incomplete occur up 14% population, leaving synchondrosis syndesmosis ossicle. When an present, it bilateral 50% patients. There 4 anatomical variants talus: I (normal process), II (elongated Stieda III (accessory bone trigonum), IV (os fused syndesmosis). Diagnosis based primarily on clinical examination history. Imaging findings support diagnosis. Patients typically complain Achilles peroneal tendons exacerbated forced wearing high-heeled shoes. history antecedent trauma. Some patients have coincident symptoms tenosynovitis manifesting radiating into arch. On physical examination, subtalar range motion should fully assessed. Care must taken differentiate Achilles-tendon–related In passive test, patient sits knee flexed 90°, multiple quick hyper– plantar-flexion movements performed ankle. vary according plain radiograph finding presence elongated known (Figure 1). degenerative change across frank disruption 2). A fracture encountered. Bone scans show abnormal radionuclide