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

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Patient History

14-year-old ballet dancer complaining of posterolateral ankle pain



Moderate-sized os trigonum or fractured Stieda process (measuring 8 x 5 mm) with diffuse osteoedema. Subjacent osteoedema of the dorsal/posterior talus, consistent with abutment/posterior impingement. Reactive sclerosis of the posterior talus. Adjacent reactive synovitis of the posterior subtalar recess with a small effusion extending into Kager’s fat pad.

No further pattern of reactive osteoedema. Focal osteochondral lesion.

No os peroneus or os navicularis. No pes planus or hindfoot valgus deformity.


Tibiotalar joint/talar dome: No osteochondral defect of the talar dome or tibial plafond.

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.

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


High ankle: Intact.

Low ankle: Intact.

Subtalar/Chopart: Intact.




Sinus tarsi: Unremarkable.

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

Soft tissue: Unremarkable.

Plantar fascia: Intact.

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

Intra-articular/loose bodies: None.


Posterior impingement with edematous os trigonum versus a fractured Stieda process with abutment/impingement.