0:00

This is a 14-year-old ballet dancer with posterior

0:04

ankle pain, sagittal fluid sensitive ester images

0:10

and T one demonstrate the presence of an all

0:14

trigonum articulating to the posterior tailor

0:19

tubercle in the setting of all Trigonum syndrome.

0:24

The OAL demonstrates very pronounced.

0:27

Diffuse marrow edema on fluid sensitive

0:31

sequences with indistinctness of the

0:35

bony trabecula on T1 weighted images.

0:39

There are also reactive marrow changes in the

0:43

opposing surface of the posterior talus with

0:46

fluid signal identified at the interface.

0:51

These are typical findings of

0:53

Osteregonome syndrome in the setting

0:56

of posterior ankle impingement.

0:57

Posterior ankle impingement syndrome

1:01

encompasses Osteregonome syndrome as well

1:05

as impingement due to alterations of the

1:10

posterior ankle ligamentous structures.

1:14

In this case, the entrapment is Related to the

1:18

presence of an ossicle interposed between the

1:22

posterior tibial lip and the calcaneus, which

1:26

isn't trapped when the patient goes into plantar

1:31

flexion related to ballet dancing activities.

Wk 4, Case 2 - Review

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0:00

This is a 14-year-old ballet dancer with posterior

0:04

ankle pain, sagittal fluid sensitive ester images

0:10

and T one demonstrate the presence of an all

0:14

trigonum articulating to the posterior tailor

0:19

tubercle in the setting of all Trigonum syndrome.

0:24

The OAL demonstrates very pronounced.

0:27

Diffuse marrow edema on fluid sensitive

0:31

sequences with indistinctness of the

0:35

bony trabecula on T1 weighted images.

0:39

There are also reactive marrow changes in the

0:43

opposing surface of the posterior talus with

0:46

fluid signal identified at the interface.

0:51

These are typical findings of

0:53

Osteregonome syndrome in the setting

0:56

of posterior ankle impingement.

0:57

Posterior ankle impingement syndrome

1:01

encompasses Osteregonome syndrome as well

1:05

as impingement due to alterations of the

1:10

posterior ankle ligamentous structures.

1:14

In this case, the entrapment is Related to the

1:18

presence of an ossicle interposed between the

1:22

posterior tibial lip and the calcaneus, which

1:26

isn't trapped when the patient goes into plantar

1:31

flexion related to ballet dancing activities.

Report

Patient History
14-year-old ballet dancer complaining of posterolateral ankle pain

Findings
SKELETAL/BONES:

Moderate-sized os trigonum or fractured Stieda process (measuring 8 x 5 mm) with diffuse osteoedema. Subjacent osteoedema of the dorsal/posterior talus, consistent with abutment/posterior impingement. Reactive sclerosis of the posterior talus. Adjacent reactive synovitis of the posterior subtalar recess with a small effusion extending into Kager’s fat pad.
No further pattern of reactive osteoedema. Focal osteochondral lesion.
No os peroneus or os navicularis. No pes planus or hindfoot valgus deformity.

ARTICULATIONS:
Tibiotalar joint/talar dome: No osteochondral defect of the talar dome or tibial plafond.
Ankle mortise/syndesmosis: The ankle mortise is in anatomic alignment. No syndesmosis widening.
Chopart joint: Unremarkable.
Midfoot/hindfoot: No fracture or injury of the anterior calcaneal process. No prominent midfoot or hindfoot arthrosis.
Lisfranc joint: The Lisfranc joint is intact, without fracture or joint space widening.

LIGAMENTS:
High ankle: Intact.
Low ankle: Intact.
Subtalar/Chopart: Intact.

TENDONS:
Intact.

GENERAL:
Sinus tarsi: Unremarkable.
Muscles: No traumatic muscle injury. No volumetric muscle atrophy.
Soft tissue: Unremarkable.
Plantar fascia: Intact.
Neurovascular complex/tarsal tunnel: Unremarkable. No evidence of entrapment neuropathy.
Intra-articular/loose bodies: None.

Impressions
Posterior impingement with edematous os trigonum versus a fractured Stieda process with abutment/impingement.

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

Practice Cases

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Practice Cases

Worklist 2

Practice Cases

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Practice Cases

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Practice Cases

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Wk 4, Case 2 - Review