The Posteromedial Impingement Lesion of the Ankle

Abstract

We report on a series of six cases of posteromedial impingement lesion of the ankle operated on during a 3-year period with excellent or good results and a return of the patients to preinjury levels of activity. This lesion occurs, on occasion, after a severe ankle-inversion injury in which the deep posterior fibers of the medial deltoid ligament become crushed between the medial wall of the talus and the medial malleolus. Initially, posteromedial symptoms do not predominate, compared with the symptoms of the lateral ligament disruption, and they usually resolve without specific treatment. Occasionally, however, thick, disorganized fibrotic scar tissue persists and impinges between the medial wall of the talus and the posterior margin of the medial malleolus. Clinically, the patient has persistent medial to posteromedial activity-related ankle pain after a severe inversion injury, despite a sound ankle rehabilitation program. There is deep soft tissue induration immediately behind the medial malleolus with localized tenderness and reproduction of symptomatic pain on provocative testing by palpating this site while moving the ankle into plantar flexion and inversion. The posteromedial impingement lesion has a distinct pathologic picture and can coexist with other ankle lesions that cause pain after lateral ligament injury.