- 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.
- The diagnosis may be confirmed on plain radiographs. Further specialist assessment may include MRI or CT.
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).
- Diagnostic uncertainty.
- Failure of minimum 3/12 conservative measures.
- Pain, stiffness, reduced function impacting on QoL.
- Referral for physiotherapy / orthotics.
- Referral for steroid injection.