In which athlete is posterior impingement syndrome most commonly seen: a basketball player, a dancer, a swimmer, or a cross-country runner?

Posterior Impingement Syndrome in Athletes

Posterior ankle impingement syndrome is most commonly seen in dancers, particularly ballet dancers, due to the extreme plantarflexion positions required in movements like en pointe and demi-pointe. 1, 2, 3

Primary Athletic Population

• Ballet dancers are the classic population for posterior ankle impingement syndrome, with the condition resulting from repetitive maximal plantarflexion where the entire body weight is applied to the maximally plantarflexed ankle 1, 3, 4
• Soccer players represent the second most common athletic group affected by this condition, also due to dynamic push-off maneuvers and forced hyperplantarflexion 2
• The extreme range of ankle motion required in classical ballet, especially in female dancers performing en pointe and demi-pointe positions, produces excessive force on the posterior ankle structures 4

Biomechanical Mechanism in Dancers

• Significant plantarflexion movements in dance lead to posterior joint impingement by compressing structures between the posterior tibia and calcaneus 3
• The condition results from chronic, repetitive trauma to the posterior ankle capsule, flexor hallucis longus tendon, and/or os trigonum during these extreme positions 2
• In ballet dancers specifically, hyaline-like cartilage generation can occur at the posterior talus, appearing as meniscus-like soft tissue on MRI, representing a unique pathological adaptation to ballet-specific movements 1

Why Not the Other Athletes

• Basketball players, swimmers, and cross-country runners do not routinely perform the extreme plantarflexion movements that characterize posterior impingement syndrome 2, 3
• These athletes may experience other ankle pathologies (such as anterior impingement or lateral ankle sprains), but lack the biomechanical stress pattern that produces posterior impingement 5
• The ACR Appropriateness Criteria specifically associates posterior ankle impingement syndrome with accessory ossicles and symptomatic findings in the context of chronic foot pain, noting its particular relevance to specific athletic populations 5

Clinical Recognition

• MRI findings in dancers with posterior impingement may show low-signal intensity meniscus-like soft tissue connecting from the posterior talus to Kager's fat pad, which can include hyaline-like cartilage tissue 1
• Open surgical treatment for posterior ankle impingement syndrome in dancers has a 90.8% success rate, confirming this as a well-recognized dance-specific pathology 6