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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

Findings

SKELETAL/BONES:

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.

ARTICULATIONS:

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.

LIGAMENTS:

High ankle: Intact.

Low ankle: Intact.

Subtalar/Chopart: Intact.

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: Unremarkable. No evidence of entrapment neuropathy.

Intra-articular/loose bodies: None.

Impressions

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