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Posterior Impingement of the Ankle Caused by Anomalous MusclesA Report of Four Cases
Alistair Best, FRCS Ed(Tr and Orth)1; Eric Giza, MD1; James Linklater, FRANZCR2; Martin Sullivan, FRACS1
1 North Shore Private Foot and Ankle Clinic, Suite 3, Level 4, North Shore Private Hospital, Westbourne Street, St. Leonards, NSW 2065, Australia. E-mail address for M. Sullivan: bunion@bigpond.net.au
2 Castlereagh Imaging and St. Vincent's Clinic, 438 Victoria Street, Darlinghurst, NSW 2010, Australia
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at The North Shore Private Foot and Ankle Clinic, St. Leonards, and St. Vincent's Clinic, Darlinghurst, New South Wales, Australia

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Sep 01;87(9):2075-2079. doi: 10.2106/JBJS.D.01916
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Posterior impingement of the ankle results from the compression of the talus and surrounding soft tissue between the tibia and the calcaneus and has been likened to a "nut in a nutcracker."1 It is produced by repetitive or forced plantar flexion of the foot and has been described in female ballet dancers, athletes, and in nonathletes after an ankle sprain1-4. Patients have pain in the posterolateral or posteromedial aspect of the ankle with activity, particularly plantar flexion. Often there is tenderness medial or lateral to the Achilles tendon, and soft-tissue thickening may be palpated. A positive posterior impingement test consists of reproduction of the symptoms with forced plantar flexion of the ankle2. The diagnosis is made on the basis of the history and physical examination of the patient and the clinical judgment of the surgeon and is supported if the symptoms are temporarily relieved by an injection of a local anesthetic and steroid into the region of the posterior process of the talus through a posterolateral approach2.
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    ankle ; pain ; vibration

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