Case Challenge

Foot & Ankle

Stephen J Pomeranz

Gain confidence interpreting Foot & Ankle MRI Cases with MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME. Try it free!

Case Review

Musculoskeletal (MSK)

Post-Course Activities

This Power Pack is comprised of 25 unique Foot / Ankle MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Foot & Ankle MRI Cases

Case 13 - 55-year-old male presents with chronic right ankle pain

<div>HISTORY:&#160;This 55-year-old male presents with chronic right ankle pain and swelling; history of talar neck fracture and degenerative joint disease (DJD).(QUIZ ANSWER) PRIMARY FINDING:&#160;Posterior impingement syndrome.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: There is obliteration of the joint space demonstrated in the posterior facet joint, less conspicuous in the medial facet joint. The sinus tarsi is narrowed but not so inflamed. There is subarticular stress-induced osteoedema and pseudocyst formation demonstrated in the facet joints. No osteochondral erosion or lesion is identified in the talar dome or tibial plafond. Mild stress-induced osteoedema is also demonstrated in the fibular end. There is chronic sprain and tear demonstrated in the lateral ligamentous complex. The deltoid ligament also demonstrates partial loss of striation. However, no tear is evident.&#160;The talonavicular and calcaneocuboid joints are intact as are the other intertarsal joints. There is focal subchondral pseudocyst formation demonstrated in the 5th metatarsal base without remarkable arthropathy. Otherwise, the tarsometatarsal joints are intact. No stress injury is demonstrated along the visualized metatarsal bones.&#160;The plantar fascia is mildly thickened without inflammation or tears. The Achilles tendon is intact. No retrocalcaneal bursal swelling or Kager's fat pad inflammation is demonstrated.&#160;An inframalleolar split tear of the peroneus brevis is demonstrated. The total length measures approximately 4cm. The peroneus longus also demonstrates moderate inframalleolar tendinosis with delicate split tears. Peritendinitis is also associated. The tibialis posterior, FDL and FHL are intact. The anterior extensor tendons are unremarkable. There is chronic stress injury and posttraumatic changes demonstrated in the fibular end.&#160;CONCLUSION: Severe posterior impingement syndrome:1. Advanced posterior facet osteoarthrosis with mild inflammation, subchondral pseudocysts, stress-induced osteoedema and joint space obliteration. Mild osteoarthrosis in the medial facet joint. Deformed and narrow sinus tarsi without remarkable active inflammation. No osteochondral erosion or lesion in the tibial plafond or talar dome.2. Stress-induced osteoedema and chronic deformity in the fibular end. Chronic tear and sprain of the lateral ligamentous complex.&#160;3. A 4cm-long inframalleolar peroneus brevis split tear and peritendinitis. Moderate inframalleolar peroneus longus tendinosis and peritendinitis.</div>

Case

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