Posterior Ankle Impact | Stieda process

Posterior Ankle Impingement Syndrome

Rheumatology clinics receive complaints about pain in the ankle region from patients almost every day. The diagnosis of posterior ankle impingement syndrome is rarely remembered within this daily routine, which may hinder effective treatment of the patient.

Continue reading to understand more about posterior ankle impingement syndrome, its characteristics, and treatment.


Diagnostic Examples

By exploring the two fictional cases below, we’ll understand the diagnosis of posterior ankle impingement syndrome. In both cases, the diagnoses were made after the patient’s clinical and radiological evaluation. Using this technique, the patient’s symptoms, as well as occupational and clinical history, were used to provide a treatment tailored to their needs.

  • 1st case—pain on the plantar face of the heel

During the examination, they found that flexing the left foot triggered the onset of pain. Magnetic resonance imaging (MRI) revealed the presence of an accessory trigonal ossicle linked to posterior subtalar arthropathy and an adjacent inflammatory process.

  • 2nd case—pain in the heels and back of the ankles

One patient experienced pain in the heels and the back of the ankles, with greater intensity on the right side. The pain had lasted for 2 years and increased in intensity when she remained standing for long periods.

During the examination, they found that the patient was in pain during the forced flexion of the feet. When performing the x-ray of the region, the presence of the trigonum (an ossicle in the region) was observed.

How does it appear?

The appearance of posterior impact syndrome occurs when there is compression of the soft tissues during plantar flexion of the ankle. This occurs between the posterior complex of the calcaneus and the posterior tibia.

Some of the probable causes of this condition may include:

  • The posterolateral process of the talus (Stieda)
  • The presence of the Os trigonum because of the impact with the adjacent structures

About 15% of people have the Os trigonum on their feet. This is a secondary ossification center in the posterolateral aspect of the talus.

Among the factors that cause pain in this region of the ankle during forced plantar flexion is trigonal process fracture.

If this stress occurs repeatedly, the patient may sustain chronic fractures. There is also a chance that the Os trigonum is symptomatic even when it remains intact during external plantar flexion.



The diagnosis of posterior ankle impingement syndrome begins with the patient’s clinical history and physical examination.

The medical exam focuses on diagnosing the condition by identifying the patient’s inability to perform certain activities in plantar ankle flexion. This includes, for instance, tiptoe support and kicking exercises.


Surgical treatment

When the patient’s condition requires surgical treatment, there are usually cases of:

  • Osteochondral injury
  • Need for repair in neurovascular structures
  • Fracture of the trigonal process

The surgical procedure (ankle surgery) begins with an open posteromedial or posterolateral incision. With a success rate of about 75%, the treatment often requires a 3–5 month rehabilitation period before returning to routine activities. In cases where the arthroscopic technique is used, the complication rate is lower and patients can resume routine activities earlier.


Now that you have a clearer understanding of the condition, its causes, and treatments, you can consult with your orthopedist for specialized information.


Nossa Estrutura

Unidade Higienópolis

Sala de espera com amplo espaço e conforto para a família que espera por uma consulta de ortopedia geral ou ortopedia infantil.

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Unidade Higienópolis
A clínica Artroplastias do ortopedista em São Paulo, Dr. Felipe possui sala para acolher o paciente e família.

    +55 (11) 99452-6862
celular +55 (11) 99949-4566

Unidade Higienópolis

Sala para um exame ortopédico completo, cujo objetivo é o diagnóstico preciso. A indicação de uma artroplastia de quadril se baseia no estudo clínico e radiográfico cuidadoso do paciente.

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