Postoperative Results of Posterior Ankle Impingement Syndrome in Athletes and Its Clinical Features

Background: Studies on posterior ankle impingement syndrome (PAIS) that focus on clinical features, characteristics, and surgical outcomes are limited. Purpose: To investigate postoperative outcomes of PAIS and identify the factors affecting it. Study Design: Case series; Level of evidence, 4. Methods: Demographic data, participating sports, the competing level of the sport, the source of pain, and concomitant pathologies were reviewed in 267 ankle samples from 240 athletes. For surgical cases, the following data were reviewed: preoperative pain duration, pre- and postoperative scores on the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, and time of return to training (RTT) and return to sports (RTS). Comparisons were statistically analyzed (1) between pre- and postoperative scores on the JSSF scale, (2) for the difference in RTT/RTS between sources of pain (bony vs soft tissue) and among sports and competition levels, and (3) for the relationship between preoperative pain duration and RTT/RTS. Results: The most common sports were ballet, followed by soccer, rugby, baseball, basketball, and swimming/water polo. Ankles of student athletes (mean ± SD age, 17.2 ± 2.6 years; range, 12-22) were the most commonly affected. The source of pain was bony impingement in 221 ankles (82.8%). The most common concomitant pathology was tenosynovitis of the flexor hallucis longus. A total of 147 ankles (55.1%) in 125 athletes were treated surgically. The preoperative JSSF scale score of 83.9 points significantly improved postoperatively to 99.4 points ( P < .00001). RTT and RTS did not differ significantly between sources of pain and among sports and competition levels. The duration of preoperative pain was significantly correlated positively with RTT and RTS ( P = .009 and P < .001, respectively). Conclusion: PAIS has been observed in many sports and is often associated with flexor hallucis longus–related pathologies, caused mainly by bony impingement. The preoperative pain duration was positively related to RTT and RTS. Surgical treatment of PAIS improves symptoms in most patients.