Posterior ankle impingement syndrome

Thickened posterior tibiotalar component of the deltoid ligament

Clinical information

This patient with severe pain in the posterior ankle, had persistent swelling at the medial side as well. No visible deformity in alignment. No signs of infection (no redness, warmth). Tenderness in the affected area and difficulties in tiptoe standing. The pain did not improve after starting to use prescribed orthotics by a podiatrist for three months ago.She uses over-the-counter pain medication, drugs like ibuprofen, which eases some of the pain. The ankle feels stiff, is painful in (downstairs) walking particularly in the morning.

Brief description

Posterior ankle impingement syndrome (PAIS) describes a collection of pathologies characterised by posterior ankle joint pain usually aggravated by plantarflexion and under repetitive load frequently leading to restriction of movement. Many different causes of PAIS have been described. PAIS should be distinguished from other causes of hindfoot pain arising from the Achilles tendon and its insertion, Peroneal sheath contents, Tibialis Posterior tendon, primary ankle and subtalar joint pathology and damage to the Tibial and Sural nerves.

Ultrasound Images & Clips

Longitudinal ultrasound  of a thickened torn posterior tibiotalar ligament
Longitudinal ultrasound of a thickened torn posterior tibiotalar ligament
Here highlighted in red
Here highlighted in red

Transducer placement
Transducer placement


The posterior tibiotalar ligament attaches to the inside of the talus and the medial malleolus. This ligament is normally extremely durable such that it can support the weight of the body and the typical range of motion of the ankle joint. Injuries to the ankle joint can injure this ligament. The deltoid ligaments are at risk of being torn as a result of an ankle sprain. The posterior tibiotalar ligament is most easily visualized for the purpose diagnosis with longitudinal plane imaging. The primary methods of treating an injury to the posterior tibiotalar ligament include rest, staying off of the injured foot, and elevating it as much as possible. It can take as long as four weeks to heal.


  • Sex: Female
  • Age: 48
  • Body part: Ankle