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Updated: Jun 8 2021

Tibiotalar Impingement

Images - lateral - colorado_moved.png
  • summary
    • Tibiotalar Impingement is a source of anterior ankle pain that is most often caused by osteophyte impingement in the anterior tibiotalar joint.
    • Diagnosis is made clinically with anterior ankle pain that worsens with forced dorsiflexion. Radiographs often show spurs in the anterior distal tibia or dorsal aspect of the talus.
    • Treatment is a trial of activity modifications, NSAIDs and corticosteroid injections. Surgical management is indicated in patients with progressive symptoms who fail nonoperative management.
  • Epidemiology
    • Demographics
      • common in athletes who play on turf or on grass including
        • rugby
        • football
        • dancers
        • soccer
  • Etiology
    • Mechanism
      • repetitive overuse injuries
      • trauma
      • degenerative sequelae
      • can also be caused by excessive anterolateral soft tissues or posterior soft tissue or osseous abnormalities
  • Presentation
    • Symptoms
      • pain in anterior ankle
    • Physical exam
      • pain with forced dorsiflexion
      • limited dorsiflexion
      • soft tissue swelling and effusion may be evident
      • subtalar joint is pain free
  • Imaging
    • Radiographs
      • recommended views
        • AP, lateral, and oblique
        • spurs seen in anterior distal tibia or dorsal aspect of the talus
        • oblique views are beneficial in revealing anteromedial talar spurs
    • CT
      • delineates extent of bony osteophytes
    • MRI
      • shows spurring and fluid in joint
  • Treatment
    • Nonoperative
      • therapy, lifestyle modifications, NSAIDS
        • indications
          • first line of treatment
      • corticosteroid injections
        • help with soft tissue impingement and synovitis-related pain
    • Operative
      • arthroscopic excision
        • indications
          • nonoperative modalities fail
  • Techniques
    • Arthroscopic excision
      • supine position with external traction device and leg over a padded bump
      • use knife to only cut the skin and use hemostat to spread to avoid neurovascular injury while making portals
      • ensure adequate field of view prior to burring or shaving anterior distal tibia to avoid iatrogenic dorsal NV bundle injury
  • Complications
    • Superficial peroneal nerve injury during anterolateral portal creation
    • Saphenous vein injury during anteromedial portal creation
    • Dorsal neurovascular bundle injury during tibiotalar spur removal
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