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Remote Fellowship – Foot & Ankle Fundamentals – 11/2/2020

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Patient History

45-year-old woman who injured her left 2nd toe 6 months prior, now complaining of pain in the same toe.

Findings

Skeletal/osseous:

High-grade subchondral osteoedema involving the head of the 2nd metatarsal, with associated very mild flattening and cortical irregularity of the metatarsal head. Moderate associated capsulitis.

Periarticular osteoedema involving the 1st tarsometatarsal articulation.

No other reactive pattern of marrow edema. No micro- or macro-trabecular fracture.

Claw toe deformities of the 2nd to 5th toes. Mild hallux valgus deformity.

Incidental bipartite tibial sesamoid, versus a remote corticated tibial sesamoid fracture. No sesamoiditis.

Articulations:

Mild to moderate capsulitis involving the 1st to 5th metatarsophalangeal joints. Capsulitis most pronounced surrounding the 2nd metatarsophalangeal joint.

Mild lateral subluxation at the 2nd metatarsophalangeal joint articulation.

Moderate to marked 1st tarsometatarsal arthrosis with focal moderate-sized penetrating osteochondral erosions and surrounding periarticular osteoedema.

Moderate to marked naviculocuneiform arthrosis with dorsal osteophytic spurring and subcortical pseudocyst formation of the navicular.

Mild talonavicular arthrosis with dorsal osteophytic spurring and moderate capsulitis with a small effusion.

Mild capsulitis/arthrosis at the tibial and fibular sesamoid phalangeal joints. 

Lisfranc joint:

Intact.

Tendon:

Intact:

Ligaments:

Intact.

Plantar plates:

Intact.

Soft tissues:

Second intermetatarsal bursal thickening without effusion. No evidence for a bulky Morton’s neuroma. Soft tissue thickening/callus formation adjacent to the 2nd and 3rd metatarsal heads, consistent with altered biomechanics of weight-bearing. Otherwise unremarkable.

Other:

None.

Impressions

  1. Early Freiberg’s infraction 2nd metatarsal head. Associated moderate capsulitis.
  2. Moderate to marked 1st tarsometatarsal arthrosis with penetrating osteochondral erosions and periarticular osteoedema. Moderate to marked naviculocuneiform arthrosis.