Capsulitis of the talar joint

Findings

a)      There is a history of trauma to the ankle followed by synovial swelling of the ankle joint, infilling the posterior aspect of the joint bilaterally and allowing ballottement of the fluid.

b)      Passive ankle flexion, extension and talar translation hurt in a capsular pattern, but trauma to the ankle usually disturbs the ligaments and tendons as well so that, clinically, there will be accompanying signs from these to confuse the diagnosis.

c)      Inflammatory disease has no history of trauma, therefore no individual ligamentous signs are found, but there is likely to be a capsular pattern of pain accompanied by systemic stigmata.

Cause

Sprain of the talar joint capsule and its ligamentous thickenings. Inflammatory joint disease.

Treatment

a)      RICE and crutches

b)      Electrotherapeutic modalities to settle inflammation, such as interferential and pulsed shortwave diathermy

c)      Non-steroidal anti-inflammatory drugs

d)     If systemic causes are suspected, then diagnostic aspiration of the joint, which must be sent for culture and crystal microscopy.

e)      Injection of cortisone to settle capsular inflammation, via either the anterior or posterior approach.

f)       Isometrics to the posterior tibialis and peroneals, to maintain strength.

g)      Balancing or wobble board exercises, for proprioceptive skills.

h)      Non-impact cross-training, such as swimming, cycling and rowing routines.

i)        Achilles ladders, when impact is permitted.

Sports

Following injury, most ankles will require supporting for 4-6 weeks after reaching match fitness.

If this is a traumatic inflammatory lesion then early cortisone injection settles it and permits earlier rehabilitation. However, if possible, take an aspirate before the injection, for culture and polarized light microscopy. Though a bone scan can be the watershed investigation separating bone and soft tissue injuries, MRI and especially MRI arthogram, is the most definitive investigation for the majority of ankle lesions.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English