This 2005 JAAOS narrative review by Maquirriain systematically covers the anatomy, etiology, diagnosis, and treatment of posterior ankle impingement syndrome (PAIS) — a clinical disorder defined by posterior ankle pain provoked by forced plantar flexion, most commonly from os trigonum or trigonal process pathology.
When a dancer, soccer player, or runner presents with deep posterior ankle pain provoked by forced plantar flexion, put PAIS on top of your differential: examine prone, reproduce pain with passive plantar flexion, and order MRI as your primary advanced imaging — it will identify trigonal process contusions and FHL tenosynovitis that X-ray and CT will miss.
If the bone scan is normal, trigonal process pathology is effectively ruled out.
This 2005 JAAOS narrative review by Maquirriain systematically covers the anatomy, etiology, diagnosis, and treatment of posterior ankle impingement syndrome (PAIS) — a clinical disorder defined by posterior ankle pain provoked by forced plantar flexion, most commonly from os trigonum or trigonal process pathology.
When a dancer, soccer player, or runner presents with deep posterior ankle pain provoked by forced plantar flexion, put PAIS on top of your differential: examine prone, reproduce pain with passive plantar flexion, and order MRI as your primary advanced imaging — it will identify trigonal process contusions and FHL tenosynovitis that X-ray and CT will miss.
If the bone scan is normal, trigonal process pathology is effectively ruled out.