11-year-old male with painful foot six months post fall

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Pain and swelling after a fall five weeks ago. Medial lateral and posterior ankle pain extending into the heel.

Long- and short-axis fat- and water-weighted images were performed. 

  • A patchy pattern of osteoedema is noted whose differential diagnosis lies between overuse syndrome and childhood RSD. Some of the areas of edema are peripherally oriented in the bone a finding that suggests regional pain syndrome or one of its variations. 
  • Especially given the relative paucity of internal derangement findings strong consideration might be given to this diagnosis which is sometimes treated with lumbar block. 
  • The physes apophyses and major ligament and tendinous structures are intact.

Patchy pattern of osteoedema some of which is peripheral raising the possibility of regional pain syndrome previously referred to as RSD.

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