Causes of posterior impingement
1.Deep posterior tibiotalar ligament (POMI lesion) 2.FHL tendon 3. Posterior intermalleolar ligament 4. Posterior tibiofibular ligament 5.Posterior talofibular ligament
Posterior impingement syndrome of the ankle is probably less common than anterior - we see at least 10:1 in favour of anterior impingement but this is in a general rather than a sports-oriented practice.
Causes in clude:
- Posterior synovitis due to trauma or frequent activities in equinus, such as classical ballet. This may be associated with injuries to the posterior talofibular, posterior inferior tibiofibular, posterior intermalleolar or deep posterior tibiotalar ligaments. The latter produces the so-called posteromedial impingement (POMI) lesion, which is thought to be mainly due to inversion injury with the posteromedial soft tissues compressed between talus and medial malleolus.
- The posterior talar process or its equivalent ossicle, the os trigonum, may be hypertrophic or fractured
- Tears or tendonopathy of the flexor hallucis longus
- Inflammatory arthritis or osteoarthritis of the ankle or subtalar joint