Osteophytes at the anterior margin of the distal tibia (Fig. 44), and at the dor-sum of the talus have been implicated in symptoms of anterior impingement . The soft tissues at the anterior aspect of the ankle may be compressed between the tibia and talus in dorsiflexion, causing pain . MRI demonstrates the osteophyte and often-associated osseous and soft-tissue edema . Surgical
Fig. 48. Normal Achilles tendon (arrow).
excision of bone spurs and debridement of impinging soft tissues is effective in relieving pain and allowing the patient to return to previous activity level
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