Challenge of the Week / Foot & Ankle / 04.010.20

A female patient who is a ballet dancer presents for evaluation of 3 weeks of worsening posterolateral ankle pain. On examination, forced passive inversion of the foot is more bothersome than forced passive plantar flexion of the foot. Pain is elicited with resisted eversion of the foot. Which of the following anatomic structures is the most likely source of her pain?
  • Peroneal tendons
  • Peroneal tendon pathology typically results in posterolateral ankle pain, reproduced with resisted active eversion of the foot as well as forced passive inversion, as is seen in this patient.

  • Os trigonum
  • With a symptomatic os trigonum, pain will typically be directly posterior. Forced passive plantar flexion will exacerbate the symptoms.

  • Stieda process
  • A Stieda process is an elongated lateral tubercle of the posterior talus, sometimes referred to as a talar process. It is similar to an os trigonum and can cause posterior impingement.

  • Posterior ankle impingement
  • With posterior ankle impingement, the pain will typically be directly posterior. Forced passive plantar flexion will exacerbate the symptoms.

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