A bursa between the FHL tendon and the posterior talar process (os trigonum region) or the sustentaculum tali as the tendon changes direction at the ankle, supplementing the FHL tendon sheath at the posterior ankle pulley. It is most prominent where the tendon wraps around the posterior talus.
FHL ankle bursitis contributes to posterior ankle impingement syndrome in dancers and gymnasts. In forced plantarflexion, the bursa is compressed between the tendon, the posterior talar process, and the calcaneus. Ultrasound confirms fluid in the FHL tendon sheath and adjacent bursal space at the posterior ankle. Arthroscopic posterior ankle decompression addresses the FHL tendon sheath, bursa, and os trigonum simultaneously.
Bursal and tenosynovial inflammation at the FHL posterior ankle pulley from repetitive plantarflexion loading, producing posterior ankle pain in maximal plantarflexion activities including ballet and gymnastics.
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