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Introduction
  • Most often caused by osteophyte impingement in anterior tibiotalar joint
  • can also be caused by excessive anterolateral soft tissues  or posterior soft tissue or osseous abnormalities
  • Epidemiology
    • common in athletes who play on turf or on grass including
      • rugby
      • football
      • dancers
      • soccer
  • Mechanism
    • repetitive overuse injuries
    • trauma
    • degenerative sequelae
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
  • 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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