flexor hallucis longus tendon ( RID3193 )
There is no os trigonum. Rather than posterior ankle impingement, I think she has entrapment or restriction of the FHL within the retrotalar tunnel. There is marked thickening and increased intrasubstance signal with fraying of the retrotalar pulley which presumably restricts gliding of the FHL. There is segmental FHL tendinosis just beyond the pulley in the hindfoot. The reference details the anatomy, describes functional hallux limitus due to blockade at the tunnel. I dont know if she has limitation; based on the referral I gather posterior ankle impingement is suspected in this ballerina. [ Article ]
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