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This is a stab in the dark but I though I would ask the question just in case anyone has experince of similar issues with patients.

I have a patient who is experiencing pain on the lateral side of his talar head and gets clicking in it when walking. When palpating it he experiences pain especially when I invert the foot. He has a history of trauma a few years ago in the left ankle (RTA) but has been fine until now and I can;t feel osteophytic formation inthe area. He has normal ankle joint and STJ movement and functionally slightyl over pronates. He was a post man and the problem has only started since he changed his job for a more office bound job. It feels like the issue is something to do with the extensor digitorum longus tendon as when he extends his toes he feels it around the area which goes under the extensor retinaculum.

Medically he does a a history of Psoriasis and has occaisionally had a prosiatic arthritic issue with his elbow which required steroid injection at the time.


Thanks for any help you may be bale to give me.

 

post tib muscle test? x ray?

 

Sorry yes Tib Post is functioning well and is strong. He hasnt had an X ray as yet, this was the next thing I advised him to do, but I just though if there was anyone who might have a clue before this.

Thanks though

 

I would suggest assessing the ATF ligament, Sinus Tarsi, possible Talar neck osteophyte.

Pain in the area with a Hx of inversion sprain is common. The opening of the Sinus Tarsi and the lateral shoulder of the ankle are in close proximity and are often not distinguished on examination; but should be.

It is more common to have anteriolateral ankle synovitis than a classic sinus tarsi syndrome. Both can be present with a talar neck spur.

A MSK US can show an extensor tendon, most likely the EDL, sliding over a bony prominence. If have also seen meniscal type structures in the ankle during arthroscopy move in and out causing a "click"

Hope that is of some help

Steve