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 2 - 64-year-old female with pain in lateral aspect of right ankle

<div>HISTORY: This 64-year-old female presents with pain in the lateral aspect of the right ankle.(QUIZ ANSWER) NOT A FINDING IN THIS CASE:&#160;Patient has a type 3 os naviculare.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS:&#160;Ligaments: The syndesmotic ligaments are normal. The anterior talofibular ligament is mildly thin and irregular consistent with a remote injury. The calcaneofibular ligament is intact. The deltoid is disorganized consistent with a remote injury.&#160;Tendons: The anterior compartment group and posterior tendons are normal. Mild fusiform thickening of the distal Achilles tendon is identified measuring a length of 4.5cm. It involves the distal 4.5cm of the insertion. It is consistent with chronic tendinopathy or healed partial tearing. Mild peroneal tenosynovitis is present. Moderate tendinopathy is identified of the distal 2cm of the insertion of the peroneus brevis tendon.The os peroneum is fractured and distracted and is identified on the radiographs.&#160;The fractured os peroneum is new when compared to previous radiograph. Moderate-to-severe bone marrow edema in the fractured os peroneum as well as within the adjacent calcaneus and to a lesser extent cuboid. A complete disruption of the peroneus longus tendon is identified at the level of the os peroneum. The approximate distance between the opposing ends is 3cm. The proximal fragment of the os peroneum is adjacent to the lateral border of the calcaneus. The distal fragment is in the cuboid tunnel. The superior retinaculum is thickened. The patient has a type 2 os naviculare.&#160;Talar dome: Intact.&#160;Sinus tarsi: Intact.&#160;Plantar fascia: Intact.&#160;Bone marrow: Degenerative changes are present at the 1st MTP joint as well as within the midfoot predominantly at the tarsometatarsal junction. No AVN or fractures are identified.&#160;CONCLUSION:&#160;1. Complete disruption of the inframalleolar aspect of the os peroneum. The disrupted tendon has occurred at the level of the os peroneum, which is fractured and distracted a distance of 3cm. The fractured os peroneum is visible on the oblique radiograph. The fractured os peroneum is new when compared to previous radiograph.&#160;2. Abnormal appearance of the anterior talofibular ligament and deltoid consistent with remote injuries.&#160;3. Fusiform thickening of the distal insertion of the Achilles tendon consistent with chronic tendinopathy or healed partial tears, which measure a length of 4.5cm.&#160;4. Degenerative changes of the midfoot and 1st MTP joint.&#160;5. Moderate bone marrow edema is identified adjacent to the calcaneus and cuboid consistent with os peroneum friction syndrome.&#160;6. Mild peroneal tenosynovitis is present. Moderate tendinopathy is identified of the distal 2cm of the insertion of the peroneus brevis tendon.</div>

Case

Complete disruption of the peroneus longus tendon at the level of the os peroneum

Moderate-to-severe bone marrow edema in the fractured os peroneum

Which of the following is NOT a finding in this case?