Posterior talar morphology as a risk factor for bony posterior ankle impingement syndrome: A propensity score-matched cohort study
4 affiliations
- 1Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
- 2Department of Orthopaedic Surgery, Obihiro Kyokai Hospital, Obihiro, Hokkaido, Japan
- 3Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Hokkaido, Japan
- 4Department of Sports Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
Abstract
Background: Bony posterior ankle impingement syndrome (PAIS) is associated with posterior talar morphology, including os trigonum and Stieda's process. However, whether these anatomical variations independently contribute to PAIS development remains unclear. This study aimed to investigate the independent association between posterior talar morphology and bony PAIS development using a propensity score-matched cohort design.
Methods: This retrospective cohort study included 752 lateral ankle radiographs of patients aged 13–65 years between April 2018 and April 2021. Posterior talar morphology was classified as Group Ⅰ (os trigonum), Group II (isolated Stieda's process), Group III (large Stieda's process without separation from the talus), and Group IV (no posterior deformity). To control for confounding by age and sex, 1:4 propensity score matching was performed. The association between posterior talar morphology and bony PAIS was evaluated using conditional logistic regression adjusted for sports participation. Interrater reliability was assessed using Cohen's kappa coefficient.
Results: Eighteen bony PAIS cases were matched to 72 controls. Adequate balance was achieved for age and sex (SMD<0.1). Interrater reliability was substantial (kappa = 0.633, p < 0.001). Os trigonum and isolated Stieda's process (Groups I and II) were significantly associated with bony PAIS (OR = 10.49, 95% CI 2.76–39.81, p < 0.001). Sports participation was not independently associated with bony PAIS (OR = 1.18, 95% CI 0.13–10.73, p = 0.884).
Conclusions: Os trigonum and isolated Stieda's process were independently associated with an approximately 10-fold increased risk of bony PAIS, though these findings should be interpreted with caution given the limited number of cases. Patients with these morphological variants engaging in repetitive plantar flexion activities should be carefully monitored.
Related
- Association of type 2 diabetes mellitus with postoperative outcomes following single-level endoscopic lumbar interbody fusion through a posterior approach: A global propensity score–matched cohort study
- Localiser-Based Software-Assisted Patient Positioning in Chest CT: A Propensity Score-Matched Study
- GLP-1 Receptor Agonists Added to Statin Therapy and Cardiovascular Outcomes in ASCVD A Propensity Score-Matched Cohort Study
- Commentary on “Postoperative complications and mechanical outcomes following endoscopic versus open lumbar fusion: a propensity-matched analysis”
- Survival and treatment selection in NUT carcinoma: a population-based study and propensity score-matched comparison with poorly differentiated head and neck squamous cell carcinoma
BibTeX
@article{mori2026posterior,
title = {{Posterior talar morphology as a risk factor for bony posterior ankle impingement syndrome: A propensity score-matched cohort study}},
author = {Yuta Mori and Yasutaka Murahashi and Tomoaki Kamiya and Takashi Matsumura and Makoto Emori and Kota Watanabe and Atsushi Teramoto},
journal = {Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology},
year = {2026},
month = oct,
doi = {10.1016/j.asmart.2026.10.005},
url = {https://doi.org/10.1016/j.asmart.2026.10.005},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Posterior talar morphology as a risk factor for bony posterior ankle impingement syndrome: A propensity score-matched cohort study
AU - Yuta Mori
AU - Yasutaka Murahashi
AU - Tomoaki Kamiya
AU - Takashi Matsumura
AU - Makoto Emori
AU - Kota Watanabe
AU - Atsushi Teramoto
PY - 2026
DA - 2026/10/27
JO - Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology
DO - 10.1016/j.asmart.2026.10.005
UR - https://doi.org/10.1016/j.asmart.2026.10.005
AB - Background: Bony posterior ankle impingement syndrome (PAIS) is associated with posterior talar morphology, including os trigonum and Stieda's process. However, whether these anatomical variations independently contribute to PAIS development remains unclear. This study aimed to investigate the independent association between posterior talar morphology and bony PAIS development using a propensity score-matched cohort design. Methods: This retrospective cohort study included 752 lateral ankle radiographs of patients aged 13–65 years between April 2018 and April 2021. Posterior talar morphology was classified as Group Ⅰ (os trigonum), Group II (isolated Stieda's process), Group III (large Stieda's process without separation from the talus), and Group IV (no posterior deformity). To control for confounding by age and sex, 1:4 propensity score matching was performed. The association between posterior talar morphology and bony PAIS was evaluated using conditional logistic regression adjusted for sports participation. Interrater reliability was assessed using Cohen's kappa coefficient. Results: Eighteen bony PAIS cases were matched to 72 controls. Adequate balance was achieved for age and sex (SMD<0.1). Interrater reliability was substantial (kappa = 0.633, p < 0.001). Os trigonum and isolated Stieda's process (Groups I and II) were significantly associated with bony PAIS (OR = 10.49, 95% CI 2.76–39.81, p < 0.001). Sports participation was not independently associated with bony PAIS (OR = 1.18, 95% CI 0.13–10.73, p = 0.884). Conclusions: Os trigonum and isolated Stieda's process were independently associated with an approximately 10-fold increased risk of bony PAIS, though these findings should be interpreted with caution given the limited number of cases. Patients with these morphological variants engaging in repetitive plantar flexion activities should be carefully monitored.
SN - 2214-6873
ER -