Published online Oct 18, 2019. doi: 10.5312/wjo.v10.i10.364
Peer-review started: June 4, 2019
First decision: July 31, 2019
Revised: August 8, 2019
Accepted: September 15, 2019
Article in press: September 15, 2019
Published online: October 18, 2019
Posterior ankle impingement is a known cause of ankle pain which has been well described in adults but not as much in the pediatric literature.
The diagnosis of posterior ankle impingement syndrome (PAIS) is made based on detailed history and clinical findings. We came across patients with missed diagnosis of PAIS in clinic and realized that without adequate awareness, this diagnosis can possibly be missed in pediatric and adolescent patients.
The purpose of our study was to identify and characterize the delay in making the diagnosis of PAIS in the young patient population.
We started a prospective study to enroll patients under 18 years of age who were diagnosed with PAIS and underwent arthroscopic treatment after failed conservative management. Data collection was done to try and identify any delay in making this diagnosis by the previous treating medical providers. Pre and post treatment pain and American Orthopedic Foot Ankle Society (AOFAS) scores were also noted and compared.
35 patients (46 ankles) with average age of 13 years had an average 19 mo (range 0-60 mo) delay in diagnosis from initial presentation to a medical provider. 25 (71%) patients had previously seen multiple medical providers. All 46 (100%) ankles had tenderness to palpation over the posterior ankle joint. Radiographs were reported normal in 31/42 (72%) exams. In 32 ankles who underwent MRI, the most common findings included os trigonum (47%)/Stieda process (47%). At an average follow-up of 13.1 mo after treatment, there was significant improvement of VAS (pre-op 7.0 to post-op 1.2) and AOFAS scores (pre-op 65.1 to post-op 93.4) (P < 0.001).
The study concludes that PAIS is a misdiagnosed condition in the pediatric population.
It was shown that a variety of medical providers (pediatricians, orthopedic surgeons, sports physicians, etc.) missed this diagnosis. There needs to be increased awareness about this condition among medical providers treating young patients.
The study makes us aware about the delayed diagnosis if PAIS which can be prevented by detailed history taking and examination. This research can be potentially improved in the future by collecting multi-center data to include larger cohort of patients.