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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lateral right ankle radiography &#40;A&#41;&#44; T1 weighted sequence &#40;B&#41; and sagittal STIR MRI sequence &#40;C&#41; images demonstrating an enlarged Stieda&#39;s process &#40;arrows&#41; with mild bone marrow and soft tissues edema&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a case of a 38-year-old female with a history of right posterior ankle pain for 2 months which worsened with walking and standing up for a long time&#46; There were no complaints in other joints&#46; On physical examination the patient presented swelling of the posterior ankle and complained of pain with forced flexion of the right feet&#46; There was no increase of inflammation parameters in blood tests&#46; Radiographic lateral view of the right ankle demonstrated an enlarged Stieda&#39;s process &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The magnetic resonance imaging &#40;MRI&#41; of the right ankle confirmed the Stieda&#39;s process &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; being able to originate posterior conflict&#44; with a subtle bone marrow edema&#46; A slight effusion was observed in the anterior and posterior compartments of the tibiotalar joint as well as edema of the subcutaneous fat&#46; The patient was told to rest and NSAID were prescribed with resolution of the hindfoot pain&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The posterior ankle impingement syndrome is a condition resulting from soft tissue compression between the posterior process of the calcaneus and the posterior tibia during ankle plantar flexion&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> An important cause of the syndrome is a prominent posterolateral talar process &#40;Stieda&#39;s process&#41; or the presence of os trigonum&#44; due to its impact on adjacent structures&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Patients usually report chronic or recurrent posterior ankle pain caused or exacerbated by forced plantar flexion&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Other causes of this syndrome may result from flexor hallucis longus tenosynovitis&#44; ankle osteochondritis&#44; subtalar joint disease&#44; and fracture&#46; Diagnosis of posterior ankle impingement syndrome is based primarily on clinical history and physical examination&#46; Radiography&#44; computed tomography&#44; and MRI are useful to detect associated bone and soft-tissue abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> MRI can identify the presence of a Stieda&#39;s process or a separate os trigonum in addition to secondary findings that suggest posterior ankle impingement as well as&#58; increased signal intensity in the soft tissues posterior to the ankle&#44; thickening of the posterior joint capsule&#44; posterior and subtalar synovitis&#44; flexor hallucis longus tenosynovitis and bone marrow edema pattern in the os trigonum and posterior talus&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8226;7</span></a> Symptoms typically improve with nonsurgical management but surgery may be required in refractory cases&#46; A literature review on conservative treatment of the posterior ankle impingement syndrome suggests that the initial treatment should aim at decreasing inflammation with non-steroidal anti-inflammatory drugs and activity restriction &#40;avoidance of forced plantar flexion&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Furthermore&#44; a physiotherapy program that includes soft tissue therapy&#44; stretching and mobilizations of restricted joints of the lower kinetic chain should be implemented in conjunction with a progressive strengthening&#44; balance and proprioception enhancement program&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a> Cortisone injections can be performed in patients with higher levels of pain&#46; These injections into the affected area may reduce the pain and allow the patient to progress into a rehabilitation program&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> It is also suggested to tape or brace the ankle in a protective dorsiflexion position when the patient undertakes intense activities&#44; such as sports&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This case emphasizes the importance of considering posterior ankle impingement due to a Stieda&#39;s process of the talus as a cause of hindfoot pain&#46; In fact&#44; it is an underrecognized cause of posterior ankle pain but imaging can easily make the diagnosis and guide appropriate treatment&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Letter to the Editor
Posterior Ankle Impingement Syndrome
Síndrome del choque posterior del tobillo
Nádia Martins
Corresponding author
nadia_filipaem@hotmail.com

Corresponding author.
, Maria Inês Seixas, Maura Couto, Paulo Monteiro
Rheumatology Department, Hospital de São Teotónio, Viseu, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a case of a 38-year-old female with a history of right posterior ankle pain for 2 months which worsened with walking and standing up for a long time&#46; There were no complaints in other joints&#46; On physical examination the patient presented swelling of the posterior ankle and complained of pain with forced flexion of the right feet&#46; There was no increase of inflammation parameters in blood tests&#46; Radiographic lateral view of the right ankle demonstrated an enlarged Stieda&#39;s process &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The magnetic resonance imaging &#40;MRI&#41; of the right ankle confirmed the Stieda&#39;s process &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; being able to originate posterior conflict&#44; with a subtle bone marrow edema&#46; A slight effusion was observed in the anterior and posterior compartments of the tibiotalar joint as well as edema of the subcutaneous fat&#46; The patient was told to rest and NSAID were prescribed with resolution of the hindfoot pain&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The posterior ankle impingement syndrome is a condition resulting from soft tissue compression between the posterior process of the calcaneus and the posterior tibia during ankle plantar flexion&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> An important cause of the syndrome is a prominent posterolateral talar process &#40;Stieda&#39;s process&#41; or the presence of os trigonum&#44; due to its impact on adjacent structures&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Patients usually report chronic or recurrent posterior ankle pain caused or exacerbated by forced plantar flexion&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Other causes of this syndrome may result from flexor hallucis longus tenosynovitis&#44; ankle osteochondritis&#44; subtalar joint disease&#44; and fracture&#46; Diagnosis of posterior ankle impingement syndrome is based primarily on clinical history and physical examination&#46; Radiography&#44; computed tomography&#44; and MRI are useful to detect associated bone and soft-tissue abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> MRI can identify the presence of a Stieda&#39;s process or a separate os trigonum in addition to secondary findings that suggest posterior ankle impingement as well as&#58; increased signal intensity in the soft tissues posterior to the ankle&#44; thickening of the posterior joint capsule&#44; posterior and subtalar synovitis&#44; flexor hallucis longus tenosynovitis and bone marrow edema pattern in the os trigonum and posterior talus&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8226;7</span></a> Symptoms typically improve with nonsurgical management but surgery may be required in refractory cases&#46; A literature review on conservative treatment of the posterior ankle impingement syndrome suggests that the initial treatment should aim at decreasing inflammation with non-steroidal anti-inflammatory drugs and activity restriction &#40;avoidance of forced plantar flexion&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Furthermore&#44; a physiotherapy program that includes soft tissue therapy&#44; stretching and mobilizations of restricted joints of the lower kinetic chain should be implemented in conjunction with a progressive strengthening&#44; balance and proprioception enhancement program&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a> Cortisone injections can be performed in patients with higher levels of pain&#46; These injections into the affected area may reduce the pain and allow the patient to progress into a rehabilitation program&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> It is also suggested to tape or brace the ankle in a protective dorsiflexion position when the patient undertakes intense activities&#44; such as sports&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This case emphasizes the importance of considering posterior ankle impingement due to a Stieda&#39;s process of the talus as a cause of hindfoot pain&#46; In fact&#44; it is an underrecognized cause of posterior ankle pain but imaging can easily make the diagnosis and guide appropriate treatment&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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