Tibio-talar Impingement

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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.