I.
1. Talotibial Exostosis
a. Talotibial- site of talus and tibia
b. Exostosis- filing up of bone at the site of irritative lesion in response to direct trama
B.
Predisposing factors such as posture, alignment, age, gender, somatotype
1. Pes cavus
2. Heel strike
3. Weight
4. Age
C.
Cause(s) - Mechanism of Injury
1. Large erosion in the neck of talus
2. Repetitive stress
3. Poorly fitting footwear
4. Direct trama
5. Push off phase of running
D.
Presentation
1. Abnormal bony outgrowth extending from the talotibial surface of the dorsal foot
Signs and Symptoms
1. Irritative lesion in response to overuse
2. Increase in bone mass at talotibial joint
3. Pain while walking
4. Swelling over dorsal aspect of foot
E.
F.
Examination and evaluation procedure
1. Palpation
a. Point tenderness
b. Tibia
c. Talus
d. Deltoid ligament
e. Medial mallelous
f. Sinus tarsi
2. Range of Motion
a. Inversion
b. Eversion
c. Ankle plantar flexion
d. Ankle dorsiflexion
e. Subtalar inversion
f. Subtalar eversion
g. Forefoot adduction
h. Forefoot abduction
3. Muscle test
a. Tibialis anterior
b. Tibialis posterior
c. Gastrocnemius
d. soleus
4.
Reflexes
a. Achilles
5.
Ligamentous stress tests
a. Inversion
b. Eversion
c. Dorsiflexion
d. Plantar flexion
e. Anterior drawer
Joint instability tests
a. Anterior drawer
b. Talar tilt
c. Wedge test
Internal derangement test
6.
7.
1
G.
H.
I.
J.
K.
L.
a. N/A
Classification (if applicable)
1. N/A
Reduction procedure(s) (if applicable)
1. N/A
Referral/Diagnostic Procedure
1. Radiography
2. Bone scan
3. CT scan
4. MRI
5. Arthroscopy
Treatment and Management
1. Rest
2. Change to shoes that have more space
3. Boot
4. Surgery to remove the exostosis
Special emergency considerations (if applicable)
1. N/A
Rehabilitation
1. Windshield wipers
2. Resistive dorsiflexion and plantar flexion
3. Active dorsiflexion and plantar flexion
M. Protection & Other Return to Competition Factors
1. Padding on dorsal aspect of the ankle
2. Cleared by physician
3. Shoes that are comfortable and that has plenty of room
Questions
1.Which is a way to test to stability of the talotibial joint?
a. anterior drawer test
b. walking
c. gait swing
d. Valgus stress
2. Talotibial exostosis is
a. a bony protrusion of the great toe
b. an abnormal bony outgrowth extending from the talotibial surface of the dorsal foot
c. degeneration of the tibia
d. talus retraction
3.Wearing shoes that fit properly is
a. a form treatment
b. vital to having healthy feet
c. common sense
d. all of the above
4.Bone scan, radiographs, and CT scans are all a form of
a. diagnostic procedure
b. observation
c. special tests
d. rehabilitation
5.Which is not a mechanism of injury for talotibial exostosis?
a. being under the age of 20
b. poor shoe quality
c. direct trama
d. erosion of talus
2