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Wk 8, Case 3, Foot/Ankle MR - Review

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Report

Patient History

69 F with foot pain and medial ankle swelling

Findings

ARTICULATIONS:

Bone: Patchy heterogeneous, feathery osteoedema scattered throughout the midfoot mainly involving the talar head and neck, the navicular, cuneiform and lateral cuboid extending to the middle subtalar, talonavicular, calcaneocuboid, naviculocuneiform and the entire tarsometatarsal joints. Pes planus.

No displaced fractures, cortical breakthrough or periosteal reactions.

Tibiotalar Joint: No osteochondral defect. No arthropathy.

Hindfoot: No arthropathy.

Midfoot: No arthropathy.

Forefoot: No arthropathy. No evidence of hallux valgus deformity.

Lisfranc Joint: The Lisfranc joint is intact, without fracture or joint space widening.

LIGAMENTS:

Anteroinferior Tibiofibular Ligament: Intact.

Posteroinferior Tibiofibular Ligament: Intact.

Interosseous Membrane and Ligament: Intact.

Anterior Talofibular Ligament: Intact.

Posterior Talofibular Ligament: Intact.

Calcaneofibular Ligament: Intact.

Deltoid Ligament Complex: Intact.

TENDONS:

Peroneus Longus/Brevis: Intact.

Posterior Tibialis: Complete rupture at the level of the medial malleolus with fluid-distended tendon sheath.

Flexor Compartment: Intact.

Extensor Compartment: Intact.

Plantar Plates: Intact.

GENERAL:

Muscles: No traumatic muscle injury. No volumetric muscle atrophy.

Soft Tissue: Diffuse reactive periarticular soft tissue swelling throughout the distal lower leg, ankle, hind and midfoot. Soft tissue edema within the Kager's fat pad.

Plantar Fascia: Intact.

Joint Effusion: Small tibiotalar and posterior subtalar joint effusions.

Intra-Articular/Loose Bodies: None.

Impressions

1. Patchy heterogeneous, feathery osteoedema scattered throughout the midfoot mainly involving the talar head and neck, navicular, cuneiform and lateral cuboid extending to the middle subtalar, talonavicular, calcaneocuboid, naviculocuneiform and entire tarsometatarsal joints. Findings in keeping with complex regional pain syndrome/Sudeck's atrophy/reflex sympathetic dystrophy. No underlying nerve lesion noted.

2. Complete rupture of the posterior tibial tendon.

3. No displaced fractures, cortical breakthrough or periosteal reactions.

4. Diffuse reactive periarticular soft tissue swelling throughout the distal lower leg, ankle, hind and midfoot.

5. Small tibiotalar and posterior subtalar joint effusions.

6. Os Trigonum

7. Pes planus

Case Discussion

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Gitanjali Bajaj, MD

Assistant Professor

University of Arkansas for Medical Sciences

Edward Smitaman, MD

Clinical Associate Professor

University of California San Diego

Brian Y. Chan, MD

Assistant Professor of Musculoskeletal Radiology

University of Utah

Tags

Musculoskeletal (MSK)

MRI

Foot & Ankle

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