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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
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Unlock access to our full Course Library and all self-paced Fellowships.
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Learn directly from the MSK Master himself.
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For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Practice Cases
Worklist 1
10 topics, 11 min.
Practice Cases
Worklist 2
10 topics, 18 min.
Practice Cases
Worklist 3
10 topics, 37 min.
Practice Cases
Worklist 4
10 topics, 7 min.
Practice Cases
Worklist 5
10 topics, 46 min.
0:00
This is a 59-year-old woman who is presenting
0:04
with chronic heel pain, history of chronic
0:07
plantar fasciitis, but acute exacerbation
0:11
of symptoms in the recent days,
0:15
and what we're seeing is the plantar fascia.
0:18
Lateral cord in this patient.
0:20
We can assess for the calibrate and signal
0:23
intensity to compare it to the central and
0:27
medial cord area where there is marked fusiform
0:32
thickening of the fibers with intrasubstance,
0:36
Longitudinal partial thickness tear
0:39
extending from the enthesis into the proximal
0:43
portion of the medial and central cords.
0:46
So this is compatible with a full thickness.
0:50
Here of the central medial quartz superimposed
0:54
on chronic plantar fasciitis outlined by
0:58
fluid signal intensity on axial images, we can
1:02
better assess the distribution of that here.
1:06
Propagating from the medial cord into the
1:09
central cord superimpose on chronic plantar
1:13
fasciitis manifested by marked thickening
1:17
and signal heterogeneity of the fibers.
1:20
There are associated findings here.
1:22
The patient has a small inferior calcaneal spur
1:27
that should be mentioned in your report as well
1:31
as Reactive marrow edema in the NTCs propagating
1:37
into the posterior inferior calcaneal tuberosity.
1:40
So this is compatible with
1:42
emphysema or emphyseopathy.
1:45
And there is also reactive edema in the adjacent
1:48
soft tissues, subcutaneous plantar fat path,
1:52
as well as adjacent intrinsic foot musculature.
Wk 1, Case 5 - Review
HIDEInteractive Transcript
0:00
This is a 59-year-old woman who is presenting
0:04
with chronic heel pain, history of chronic
0:07
plantar fasciitis, but acute exacerbation
0:11
of symptoms in the recent days,
0:15
and what we're seeing is the plantar fascia.
0:18
Lateral cord in this patient.
0:20
We can assess for the calibrate and signal
0:23
intensity to compare it to the central and
0:27
medial cord area where there is marked fusiform
0:32
thickening of the fibers with intrasubstance,
0:36
Longitudinal partial thickness tear
0:39
extending from the enthesis into the proximal
0:43
portion of the medial and central cords.
0:46
So this is compatible with a full thickness.
0:50
Here of the central medial quartz superimposed
0:54
on chronic plantar fasciitis outlined by
0:58
fluid signal intensity on axial images, we can
1:02
better assess the distribution of that here.
1:06
Propagating from the medial cord into the
1:09
central cord superimpose on chronic plantar
1:13
fasciitis manifested by marked thickening
1:17
and signal heterogeneity of the fibers.
1:20
There are associated findings here.
1:22
The patient has a small inferior calcaneal spur
1:27
that should be mentioned in your report as well
1:31
as Reactive marrow edema in the NTCs propagating
1:37
into the posterior inferior calcaneal tuberosity.
1:40
So this is compatible with
1:42
emphysema or emphyseopathy.
1:45
And there is also reactive edema in the adjacent
1:48
soft tissues, subcutaneous plantar fat path,
1:52
as well as adjacent intrinsic foot musculature.
Report
Patient History
59-year-old woman with previous plantar fasciitis, complaining of right ankle pain for 2 months
Findings
SKELETAL/BONES:
Moderate-sized plantar calcaneal spur, at the origin of the plantar fascia with associated moderate to marked periostitis and osteoedema.
No other pattern of reactive osteoedema. No micro or macro trabecular fracture. No aggressive osseous abnormality. No stress fracture.
No os trigonum.
No hindfoot valgus deformity.
ARTICULATIONS:
Tibiotalar joint/talar dome: No osteochondral defect of the talar dome or tibial plafond. Mild capsulitis.
Ankle mortise/syndesmosis: The ankle mortise is in anatomic alignment. No syndesmosis widening.
Chopart joint: Mild capsulitis of the posterior subtalar joint, with a small capsular bursal cyst. Otherwise unremarkable.
Midfoot/hindfoot: No fracture or injury of the anterior calcaneal process. No prominent midfoot or hindfoot arthrosis. Mild 2nd tarsometatarsal joint arthrosis with periarticular osteoedema.
Lisfranc articulation: Unremarkable. Intact Lisfranc ligament.
LIGAMENTS:
High ankle: Intact.
Low ankle: Slightly thickened scarred ATFL. Otherwise unremarkable low ankle ligaments.
Subtalar/Chopart: Intact.
TENDONS:
Intact.
GENERAL:
Sinus tarsi: Unremarkable.
Muscles: Moderate fatty atrophy involving abductor digiti minimi. Otherwise unremarkable intrinsic musculature of the foot.
Soft tissue: Unremarkable.
Plantar fascia: Markedly thickened proximal central cord of the plantar fascia, with a deep, near full-thickness or full-thickness incomplete tear adjacent to the calcaneal origin, measuring 1.1 cm AP diameter, 0.8 cm transverse diameter. Marked perifascial high signal inflammation noted and prominent plantar calcaneal periostitis.
Moderately thickened lateral and mildly thickened medial cords proximally.
Neurovascular complex/tarsal tunnel: Unremarkable. No evidence of entrapment neuropathy.
Intra-articular/loose bodies: None.
Impressions
1. Marked active plantar fasciitis, most prominently involving the central cord, with a focal full-thickness or near full-thickness incomplete tear measuring 1.1 x 0.8 cm. Auto-release could account for recent symptom relief.
2. Moderate-sized plantar calcaneal spur with moderate to marked periostitis and reactive osteoedema.
3. Diffuse abductor digiti minimi fatty atrophy, consistent with coexisting Baxter’s neuropathy.
Case Discussion
Faculty
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Jenny T Bencardino, MD
Vice-Chair, Academic Affairs Department of Radiology
Montefiore Radiology
Edward Smitaman, MD
Clinical Associate Professor
University of California San Diego
Tags
Musculoskeletal (MSK)
MRI
Foot & Ankle
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