Anterior Ankle Impingement and Talar Bony Outgrowths: Osteophyte or Enthesophyte? Paleopathologic and Cadaveric Study With Imaging Correlation

Bony "spurs" are a major component of anterior ankle impingement syndrome. The two major accepted hypotheses on the origin of these bony spurs are osteophyte formation due to repetitive microtrauma and enthesophyte development because of recurrent capsular or ligamentous traction. The purpose of this study was to provide a detailed evaluation of the bony outgrowths that arise on the anterior aspect of the talus and correlate them with the sites of capsular attachment. Twenty-eight well-preserved talus bones from the San Diego Museum of Man were assessed regarding the presence of outgrowths on the anterior aspect of the talus. The distance of the outgrowths from the talar head was measured. The results were correlated with measurements of capsular attachment on the anterior aspect of the talus derived from MR arthrographic images in 13 cadaveric ankles. The average distance of capsular attachment from the talar head in the medial aspect of the bone was 10.63 mm and in the lateral part was 12.04 mm. The mean distance of bony spurs from the talar head in the medial and lateral parts of the talus was 17.2 and 12.5 mm, respectively. Medially, the talar spurs developed more proximally on the neck compared to the capsular attachment (p < 0.01). Laterally, this difference was not significant (p = 0.26). On the medial part of the anterior talus, bone development appears to occur in an intraarticular location (i.e., osteophytes). Laterally, the outgrowths develop extraarticularly and appear to result from capsular and ligamentous traction (i.e., enthesophytes).