Prevalence and location of bone spurs in anterior ankle impingement: A cadaveric investigation

Abstract

Anterior ankle impingement (AAI) results from repetitive microtrauma leading to pain and decreased dorsiflexion due to spur formation and synovial hypertrophy. Information about the prevalence of anterior spur formation in a large population, and the individual contributions of the talus and tibia to osseous impingement, is limited. A total of 670 ankle specimens from 344 individuals (n = 111 females, n = 233 males) aged 20 to 40 years at the time of death were examined. Matching tibia and talus were opposed and any spurring causing impingement was recorded. Spur locations were measured and ratios calculated to allow for inter-specimen comparison between: (1) medial-to-lateral and anterior-to-posterior spur location versus dimensions of talar neck width, and (2) medial-to-lateral spur location to dimensions of distal anterior tibial width. Differences in spur prevalence in relation to sex, race, height and age were identified by univariant and multivariable statistical analyses. Bony impingement was observed in 21% (n = 72) of specimens, with bilateral involvement in 8% (n = 27). For ankles with AAI, spurs were seen on the talus only in 61%, on the tibia only in 14%, and on both the tibia and talus in 26%. Spurs were significantly more prevalent in males (P = 0.001) and with increasing specimen age (P = 0.002). There were no significant differences related to specimen height or race. Spurs were predominately located on the anterolateral talus (78%) and the anterolateral portion of the distal tibial margin (80%). AAI was present in 21% of young osseous specimens and was significantly more prevalent in males and with increasing specimen age. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.

Risk Factors for Osteochondral Lesions and Osteophytes in Chronic Lateral Ankle Instability: A Case Series of 1169 Patients

“…12,20 A study of 670 ankle specimens from 344 cadavers found osteophytes in 21% of specimens, and spurs were significantly more prevalent in male than female and in older versus younger cadavers. 19 Sex-based differences in the incidence of osteophytes require further research. Similar to OCLs, osteophytes were significantly increased in patients with CLAI with a postinjury duration of more than 5 years.…”

Anteromedial Ankle Impingement Due to a Talar Cam Lesion and Anterior Deep Deltoid Ligament With Variant Anatomy: A Case Report

“…11 In addition, these osteophytes can cause swelling and restriction to the biomechanical motion of the ankle joint. A cadaveric investigation by Talbot et al 10 revealed that spurs were found in the anterolateral talus in 78% of their specimens and also in 80% of the anterolateral portion of the distal tibial margin.…”

Statistical shape model of the talus bone morphology: A comparison between impinged and nonimpinged ankles

“…6,7 The mechanisms that create obstruction and give rise to pain in both anterior and posterior bony ankle impingements are driven by abnormalities in the morphology of ankle bones, mainly osteophytes (bone spurs) in the tibia and talus. 6,8,9 In the anterior bony ankle impingement, the pain occurs during dorsiflexion of the foot, when osteophytes on the talar neck or distal tibia entrap the soft tissues in the anterior part of the ankle joint or when these osteophytes undergo irritation because they collide with each other or receive an external force. 2,10 In posterior bony ankle impingement, on the other hand, obstruction and pain happen when during plantarflexion of the foot some soft tissues get squeezed in the area between the tibial rim or calcaneus and the bony excess of the posterior side of talus, including os trigonum and Steida's process, or when an action like a plantarflexion or an external force affects the posterior process of the talus.…”

“…Based on pathoanatomic features developing ankle impingement, it is divided into bony ankle impingement (also known as ankle impingement exostosis 4,5 ) and soft tissue ankle impingement 6,7 . The mechanisms that create obstruction and give rise to pain in both anterior and posterior bony ankle impingements are driven by abnormalities in the morphology of ankle bones, mainly osteophytes (bone spurs) in the tibia and talus 6,8,9 …”

“…Berberian and colleagues documented size measurements of tibial and talar osteophytes on plain radiographs and axial CT images of nine anterior ankle impingement patients 7 . A more recent study documented the coordinate location and size of the osteophytes from the cadaveric talus and tibia of a population with bony ankle impingement syndrome 8 …”