Tibio-talar Impingement

Patient Information

https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/ankle-anterior-impingement.html

GP Information

Background Information

• Osteophyte impingement or excessive soft tissue in the tibiotalar joint.
• Classically due to repetitive overuse injuries or trauma.
• Patients typically complain of anterior ankle pain.
• Examination may reveal reduced and painful passive dorsiflexion +/- a soft tissue swelling anteriorly.

Investigation Guidelines

• The diagnosis may be confirmed on plain radiographs. Further specialist assessment may include MRI or CT.

Management Recommendations

Initial management is conservative:

• Provide verbal and written information to patient.
• Avoid activities that precipitate symptoms. Formal physiotherapy.

Analgesia should include:

• Regular paracetamol
• Topical NSAIDs
• Consider oral NSAIDs, opiods, intra-articular steroid injection (XR-guided).

Referral Indications

• Diagnostic uncertainty.
• Failure of minimum 3/12 conservative measures.
• Pain, stiffness, reduced function impacting on QoL.
• Referral for physiotherapy / orthotics.
• Referral for steroid injection.