Posterior Ankle Impingement: Two-Portal Hindfoot Endoscopy

In general, patients with posterior ankle impingement problems are treated conservatively first. Conservative interventions include rest, nonsteroidal anti-inflammatory drugs, physical therapy modalities, or intra-articular cortisone injections. When conservative treatment fails, endoscopic surgery is indicated in these patients. Good functional and clinical outcomes have been described after endoscopic excision of an os trigonum, hypertrophic posterior talar process, posterior tibial or talar osteophytes, and soft tissue overgrowth.1-6 In cases where athletic patients require a prompt return to athletic play, surgery is often recommended initially or very early in the treatment process without a significant time period spent attempting conservative therapy. If complaints of posterior ankle impingement cause a substantial decrease in functioning and imaging reveals a bony cause, surgical resection is indicated.7.