The posteromedial impingement lesion of the ankle - A series of six cases

We report on a series of six cases of posteromedial impingement lesion of t he 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 o ccurs, 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, posteromedia l symptoms do not predominate, compared with the symptoms of the lateral li gament disruption, and they usually resolve without specific treatment. Occ asionally, however, thick, disorganized fibrotic scar tissue persists and i mpinges between the medial wall of the talus and the posterior margin of th e medial malleolus. Clinically, the patient has persistent medial to poster omedial activity-related ankle pain after a severe inversion injury, despit e a sound ankle rehabilitation program. There is deep soft tissue induratio n immediately behind the medial malleolus with localized tenderness and rep roduction of symptomatic pain on provocative testing by palpating this site while moving the ankle into plantar flexion and inversion. The posteromedi al impingement lesion has a distinct pathologic picture and can coexist wit h other ankle lesions that cause pain after lateral ligament injury.