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 findings 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