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

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Patient History

51-year-old man complaining of Achilles pain for 2 weeks with no inciting event

Findings

SKELETAL/BONES:

Prominent/dysplastic anterior calcaneal process with cortical irregularity and joint space loss at the calcaneonavicular articulation, consistent with a nonosseous calcaneonavicular coalition. Minor subcortical cystic change adjacent to the calcaneal aspect of the coalition. Nominal osteoedema surrounding the coalition.

Concomitant nonosseous talocalcaneal coalition of the middle facet (with joint space loss, cortical irregularity and prominence of the middle subtalar facet). Moderate surrounding stress related osteoedema and subcortical cystic change.

Ill-defined osteoedema surrounding an ill-defined linear area of low signal that contacts the cortex of the posterolateral calcaneus, consistent with a microtrabecular stress fracture.

Mild dorsal calcaneal enthesophyte formation with low-grade osteoedema and periostitis.

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

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: Nonosseous Calcaneonavicular and talocalcaneal coalitions as described above. Moderate stress-related osteoedema and fibrocystic change surrounding the talocalcaneal coalition. Moderate posterior subtalar facet osteoarthrosis with osteophytosis and joint space loss.

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

LIGAMENTS:

High ankle: Intact.

Low ankle: Intact. Small chronic intrasubstance partial-thickness cystic tear distal ATFL.

Subtalar/Chopart: Intact.

TENDONS:

Intact. Mild peritendinous high-signal edema superficial to the distal Achilles insertion, consistent with insertional enthesitis.

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

  1. Nonosseous talocalcaneal coalition (involving middle facet). Moderate surrounding reactive osteoedema and subcortical degenerative cystic change.
  2. Nonosseous calcaneonavicular coalition. Nominal surrounding osteoedema and subcortical cystic change.
  3. Microtrabecular stress fracture posterolateral calcaneus (likely due to altered biomechanics of weight-bearing related to the above coalitions).
  4. Mild insertional Achilles enthesitis.