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 4 - 58-year-old male with right ankle pain

<div>HISTORY:&#160;This 58-year-old male presents with right ankle pain.(QUIZ ANSWER) PRIMARY FINDING:&#160;Haglund deformity.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Hypertrophic Achilles tendinopathy with foci of mid substance interstitial microtearing is noted punctuated by enthesopathic insertional footprint tear:&#160;&#160;a. Superior posteromedial sharp-edged Haglund deformity.&#160;&#160;b. Supracalcaneal undersurface fraying-type tear and active inflammation with supracalcaneal secondary bursitis.&#160;&#160;c. Peeling of the mid to inferior footprint in the retrocalcaneal region.&#160;&#160;d. Traction enthesopathic erosion and stress reaction.&#160;&#160;e. Kager's space swelling.&#160;&#160;f. Consider superimposed secondary CPPD or crystalline deposition due to the chronicity and extent of inflammation.&#160;&#160;Due to altered mechanics of weightbearing, inferolateral subtalar bursal cyst so-called "stem ligament cyst" projecting dorsolaterally.&#160;&#160;Ankle joint unremarkable.&#160;&#160;Sinus tarsi ligaments normal.&#160;&#160;Ankle ligaments normal although the stem ligament bursal cyst sits directly atop the anterior talofibular ligament.&#160;&#160;Medial tendon group normal.&#160;&#160;Lateral tendon group normal.&#160;&#160;Anterior tendon group normal.&#160;&#160;Skeleton normal with type 2 accessory navicular identified. This, with the exception of the enthesopathic changes and Haglund deformity of the calcaneus.&#160;&#160;Plantar fascia normal.&#160;&#160;CONCLUSION:&#160;&#160;Multifocal areas of interstitial microtearing of the Achilles punctuated by prominent Haglund deformity and undersurface fraying-type tear whose depth is approximately 20% or less of a hypertrophic tendon. Subtle peel phenomenon of the mid to inferior footprint with enthesopathic calcaneal erosions and sharp-edged pump-bump.</div>

Case

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