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Posterior Ankle Impingement Syndrome
synonyms:Os Trigonum Syndrome, PAIS, talar compression syndrome, os trigonum impingement syndrome, nutcracker syndrome.
PAIS ICD-9
PAIS Etiology / Epidemiology / Natural History
- Most commonly in ballet dancers, soccer players, and runners.
- Can be stress injury from repetitive plantar flexion, or a synchondrosis disruption from a plantar flexion-inversion injury
- Os Trigonum syndrome: inflammation between the os trigonum and the adjacent talus.
PAIS Anatomy
PAIS Clinical Evaluation
- Posterior ankle pain exacerbated by plantar flexion.
- Consider fluoroscopically guided local anesthetic injection. Significant relief of symptoms after injection strongly points to that structure as a source of the pain and may have predictive value for surgical treatment.
PAIS Xray / Diagnositc Tests
- A/P, Lateral and Mortise ankle xrays may be normal.
- MRI: demonstrates intraosseous edema in the os trigonum and adjacent talus and calcaneous
- Bone Scan: may demonstrate focal intense Tc-99m uptake in the posterior aspect of the talus and adjacent tibia as well as in the calcaneous. High false-positive rate (Sopov V, Foot Ankle Int 2000;21:822)
PAIS Classification / Treatment
- Os Trigonum syndrome: definitive treatment = excision of the os trigonum via a medial approach. (Abramowitz Y, JBJS 2003;85A:1051).
PAIS Associated Injuries / Differential Diagnosis
PAIS Complications
PAIS Follow-up Care
PAIS Review References
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