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

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Patient History

24-year-old man complaining of left ankle pain after lifting

Findings

SKELETAL/BONES:

Large chronic left medial talar osteochondral defect, measuring 2.9 cm AP by 1.1 cm transverse by 0.9 cm deep. Osseous remodeling with moderate-to-marked flattening of the affected talar dome. Stress-related adjacent osteoedema throughout the talar dome. No T2 hyperintense fluid cleft to suggest potentially unstable fragment. No displaced osteochondral body identified.

Scuffing of the posterior aspect of the talar dome, with an adjacent small to moderate-sized os trigonum. Low-grade osteoedema through the os trigonum. Prominent synovitis throughout the posterior tibiotalar recess.

Moderate talofibular arthrosis with stress-related osteoedema of the distal fibula and lateral talus and a small subcortical pseudocyst of the distal fibula.

No further pattern of reactive osteoedema. No micro- or macro-trabecular fracture. No aggressive osseous abnormality.

Incidental pes planus deformity noted.

ARTICULATIONS:

Tibiotalar joint/talar dome: Large osteochondral defect/erosion of the talar dome as described above. Moderate secondary tibiotalar arthrosis with spurring of the anterior tibial plafond and and anterior talar dome. Prominent diffuse capsulitis with prominent posterior tibiotalar synovitis, extending out to the adjacent large osteochondral defect.

Ankle mortise/syndesmosis: The ankle mortise is in anatomic alignment. No syndesmosis widening.

Chopart joint: Unremarkable.

Midfoot/hindfoot: No fracture or injury of the anterior calcaneal process. No prominent midfoot or hindfoot arthrosis.

LIGAMENTS:

High ankle: Remote high ankle sprain with thickened, scarred anterior tibiofibular ligament. Intact interosseous ligament and posterior tibiofibular ligament. No syndesmotic diastasis.

Low ankle: Intact.

Subtalar/Chopart: Attenuated cervical and interosseous ligaments. Spring ligaments intact and unremarkable.

TENDONS:

Intact.

GENERAL:

Sinus tarsi: Unremarkable.

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

Soft tissue: Unremarkable.

Plantar fascia: Intact.

Neurovascular complex/tarsal tunnel: No evidence of entrapment neuropathy.

Loose bodies: Tiny mm sized mineralized fragments/osseous bodies are seen scattered through the posterior tibiotalar synovitis.

Impressions

  1. Large chronic “NON-SHOULDERED” medial talar dome osteochondral defect/erosion with flattening of the articular surface and moderate subjacent stress reaction. No unstable or displaced osteochondral fragment.
  2. Moderate secondary tibiotalar arthrosis with active capsulitis. Posterior tibiotalar synovitis with tiny metaplastic mineralized bodies.
  3. Moderate talofibular arthrosis.