Table 1 Previous studies on the patient profile, diagnosis, symptoms, treatment, and clinical significance of SP
Author | Year | Place | Number/age/sex | Symptoms | Study design | Pathology | Treatment | Significant outcomes |
|---|---|---|---|---|---|---|---|---|
Yilmaz et al | 2006 | Mersin/ Turkey | 1/19/M | -Posterior ankle pain after trauma -PAIS of SP -Tenderness (posteromedial ankle) | AP Lateral, Mortise Stress Radiographs | Long SP Long calcaneal process | -Conservative (shortleg cast for 6 weeks) (failed) -Arthroscopic excision | -SP is a rare cause of PAIS -Refractory to conservative treatment, arthroscopic excision allows for easy and more satisfactory excision than open excision |
Perdikakis et al | 2010 | Greece | 1/27/ M | -Progressive posterior ankle pain -Mild swelling and tenderness (posterolateral ankle) -Restriction during plantar and dorsal flexion -Haglund’s deformity in calcaneus | Plain X-ray MRI | -Marrow edema and small effusion of tibiotalar joint -Soft-tissue edematous and fibrotic changes in periarticular fat | -Conservative -physiotherapy -arthroscopic -open debridement | Conventional radiographs and CT may show SP, but MRI is required to confirm if these findings are the source of symptoms |
Sánchez Prida et al | 2016 | Spain | 1/40/ M | -Right ankle pain without trauma -PAIS-related symptoms -Radiating pain -Stiffness -Pain with plantar flexion and palpation | Plain X-ray (Lateral view) | No signs of inflammation, edema or skin changes, or the presence of asymmetries or deformities in ankles | -NSAID, analgesics, joint rest, immobilization -Physiotherapy -Manual mobilization -Kinesio tape -Ultrasound -Transcutaneous electrical nerve stimulation (TENS) -Dry needling -Percutaneous treatment with corticosteroids -Arthroscopy, open surgery | -When the pain appears in the posterior ankle, especially plantar flexion, and there is no previous history of trauma, we must be aware of PAIS caused by SP -Plantar hyperflexion produces the “nutcracker phenomenon,” in which the inferior–posterior tibial platform and the posterosuperior part of the calcaneus form a pincer that compresses the SP against the surrounding soft tissues |
Cuéllar-Avaroma et al | 2017 | Mexico | 24/31.8 ± 5.26 years/ M:19, FM:5 | -Chronic pain PAIS-related symptoms -complex regional pain syndrome | X-ray | Wound erythema | -Conservative -posterior ankle endoscopy -physical therapy -immobilization -arthroscopic treatment | The arthroscopic treatment is an ideal option as it presents an excellent postoperative recovery with a swift return to patients’ preoperative sports activities |
Moore et al | 2018 | Oregon/ USA | 1/39/F | -Pain (Posterior ankle) -Swelling after trauma (left ankle) -Impairment in the plantar flexion | Radiographs | Long SP | -Conservative (shortleg cast for 6 weeks) -Serial follow-up radiographs at 2, 4, and 8 weeks | -SP fracture could be misdiagnosed as an accessory ossicle, OT, because of its similar appearance and location -It is essential to recognize and identify the fracture early to ensure proper management |
Lourenço et al | 2018 | Portugal | 1/35/M | -Posterior ankle pain without trauma (right) -Pain anterior to the Achilles tendon | Radiography CT/MRI STIR | -Inflammatory changes with SP -Inflammatory process of soft tissues near SP -Joint effusion -Palpable soft-tissue thickening | -Conservative treatment (local corticosteroid injection and 4–6 weeks of immobilization) -Arthroscopic excision | -SP is a rare cause of PAIS, and radiologists must be aware of this differential diagnosis -Arthroscopic excision can be used in refractory cases, and complete recovery is attained in a shorter time than open excision |
Martins et al | 2018 | Portugal | 1/38/FM | -Posterior ankle pain without trauma (right) -Pain with forced flexion of the right feet -Swelling (posterior ankle) -PAI syndrome of SP | Lateral Radiography Sagittal STIR/MRI | -Enlarged SP -Bone marrow edema -Slight effusion -Edema of the subcutaneous fat | -NSAID -Cortisone injections -Rehabilitation, physiotherapy (soft-tissue therapy, stretching, mobilization) -Tape or brace the ankle in dorsiflexion -activity restriction (avoidance of forced plantar flexion) | SP is an under-recognized cause of PAI, but MRI can easily make the diagnosis and guide appropriate treatment |
Cicek et al | 2020 | Istanbul | 1088/35.86 ± 15.79 (15–95) / M: 576 (52.9%) FM: 512 (47.1%) | -PAIS-related symptoms -Excessive repetitive plantar flexion (ballet dancers, gymnasts, basketball, soccer, and football players) or traumatic events | Lateral ankle radiographs | Prominent posterolateral talar process (7.3 mm) | -Conservative -arthroscopic -open debridement | -¼ of the Turkish population had SP or OT, which made them susceptible to PAIS. The prevalence of SP was higher than that of OT, and both were more frequent in males than in females -Therefore, clinicians should provide early diagnosing and treatment SP for ankle health management |
Micheli et al | 2021 | Boston/ USA | 54/22.7 ± 6.1 years/ FM:53, M:1 | -PAIS-related symptoms -Anterior ankle impingement -Recurrent tenosynovitis -complex regional pain syndrome | Lateral Radiography CT | -Abnormalities of the SP -painful OT of the talus | -The posterolateral surgical approach -Posterior ankle decompression with physical therapy -Corticosteroid injections under ultrasound -medication -physical therapy -IV antibiotic treatment | The resection of OT and SP via the posterolateral approach is a safe and effective solution |
Symeonidis et al | 2021 | Greece | 30/31.46 ± 10.70 (17–48) years M:10, FM: 3 | PAIS-related symptoms | MRI and CT | -SP -OT -Lateral ankle instability -Haglund deformity -Osteochondral lesion of the talus | -Conservative (physiotherapy, modification of activities single ultrasound-guided betamethasone injections) -Posterior arthroscopy -SP resection | -Better FFI outcomes were observed in the resection of the OT group at a 6-month follow-up -Significant AOFAS and FFI improvement were observed from 6-month to 12-month follow-up |