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12b - Answer: 54-year-old male with pain in right ankle

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 54-year-old male presents with diabetes, Charcot foot, and pain in the right ankle.

(QUIZ ANSWER) MARKED DEFORMITY IS DEMONSTRATED IN: 

All of the above.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

Diffuse abnormality at the level of the midfoot with osseous deformity, fracturing, and complex capsulosynovitis consistent with evolving Charcot arthropathy. Deformity of the anterior calcaneus, cuboid, anterior talus, and tarsals is demonstrated. Tendons medially, anteriorly, and posteriorly are intact. Complex fluid within the flexor hallucis longus tendon sheath for which complex tenosynovitis and hemorrhage within the tendon sheath is favored. 

The peroneus brevis tendon is intact. The peroneus longus tendon is torn at the level of the cuboid. Mild retraction is demonstrated. Diffuse soft tissue swelling is noted. Superimposed infection at the level of the midfoot is difficult to exclude and for which clinical correlation and/or sampling may be of value. 

Diffuse stress injury and/or hyperemic marrow is noted within the distal fibula and distal talus as well. Diffuse marrow reaction involves the talus and calcaneus. 

CONCLUSION

1. Massive Charcot arthropathy pattern with evolving osteolysis and fracturing at the level of the midfoot. Marked deformity of the anterolateral calcaneus, cuboid, anterior talus, navicular, and cuneiforms is demonstrated. 

2. Peroneus longus is not visualized proximal to the cuboid and is torn. The tendon is visualized at the level of the peroneal tubercle. A gap of at least 2 to 3cm is demonstrated. 

3. Please see above.

LESSON 2, TOPIC 36

Case Challenge: Foot & Ankle MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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