Posterior pain after posterior malleolar fracture

Posterior Ankle Pathology

Description of patient (type of occupation, indication of age, intensity of sport):

Female, 62 years old.

History and previous treatment:

Inversion trauma 1 year ago. Diagnosed with undisplaced posterior malleolar fracture, treated non operatively.

Current complaints:

Posteromedial ankle pain and pain when she uses high heeled shoes.

Physical examination:

Neutral alignment. Pain at forced plantar flexion. Posteromedial pain.


Shows a consolidated posterior malleolar fracture. Absence of os trigonum or stieda process.

Additional investigation (CT/MRI):
[PICTURE 1 + 2]


Case summary:

Posterior ankle pain after non displaced posterior malleolar fracture.

Question(s) to this case:

The source of the pain is post traumatic arthritis or a posterior ankle impingement?


Pain most likely is from the intraarticular damage caused by the fracture. A small cyst can already be seen as sign of high local pressure/forces. There also seems to be a slight mismatch (malunion) which looks too small to warrant a correction osteotomy.
Advice is to adjust activities and/or adjust heelsize (limited high heels) If this is not acceptable to the patient then you could go with posterior ankle arthroscopy and judge the situation and remove cartilage flaps or possibly microfracture the fracture line at the level of the cyst.