Musculo-skeletal   [back to the Category]

The tibio talar syndrome or anterior impingement syndrome   [read the french version]

Author :   Dr Anne Thiesce

The anterior impingement syndrome causes pain and/or a restriction to maximum dorsiflexion of the tibio-talian articulation.

This maximum dorsiflexion is used in ballet dancing for jump preparation and reception in the "demi-plié". Jump amplitude can be diminished when this dorsiflexion is painful or restricted.

Repeated maximum plantar flexion, required in ballet dancing on "pointes", "demi-pointe" or in "pointé", creates a capsular stretching of the tibio-talian articulation and, consequently, osteophytic traction reactions.

Tibio-talian osseous contact, as in dorsiflexion, can result in the formation of mirror cupule on the anterior edge of the tibia and on the neck of the talus.

A strict profile X-ray shows the osteophytic reactions of the anterior curb of the tibia, and the strict profile with maximum dorsiflexion X-ray, the anterior tibio-talian osseous contact.


Treatment is initially medical: relative rest with painful gestures being restricted, NSAID taken orally or applied locally, ice treatments, local physiotherapy and articular traction movement. It can be necessary to turn to infiltrations, even an arthroscopic or surgical cleaning of the osteophytes.


Bibliography:

Desmarais Y. Lésions articulaires micro-traumatiques du pied chez le danseur. Sciences et Sports 1986; 1: 331-336.

Thiescé A. Le geste dansé et ses conséquences en rhumatologie. Paris: ed Printel, Laboratoires Ciba-Geigy 1996.

Thiescé A. Pied et danse classique. Encycl Méd Chir (ELSEVIER, Paris), Podologie, 27-140-A-65, 1999, 7p.