The posterior process is the backward projection of the talus, made up of a lateral tubercle and a medial tubercle separated by a groove for the flexor hallucis longus tendon. The posterior talofibular ligament attaches to the lateral tubercle and part of the deltoid ligament to the medial tubercle. In some people the lateral tubercle forms as a separate small bone, the os trigonum.
| Articulations | |
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| Landmarks |
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| Ossification | Part of the talus, which ossifies from a single primary centre appearing around the seventh fetal month; a separate centre for the lateral tubercle appears at about 8-11 years and fuses within a year, but remains separate as an os trigonum in some people. |
The posterior process is the site of posterior ankle impingement, common in ballet dancers and footballers, where repeated forced pointing of the foot squeezes the process or an os trigonum between the tibia and calcaneus. Fractures of the lateral tubercle (Shepherd fracture) and medial tubercle (Cedell fracture) are easily missed on plain X-rays. Flexor hallucis longus tendinopathy often occurs in the groove between the tubercles.
Pain at the back of the ankle with forced plantarflexion from compression of the posterior process or an os trigonum, typical in dancers.
A fracture of the lateral tubercle of the posterior talar process, often mistaken for an ankle sprain or an os trigonum.
Irritation of the FHL tendon in its groove between the posterior tubercles, causing posteromedial ankle pain and sometimes triggering of the big toe.
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