Wk 1, Case 5 - Review

Patient History
59-year-old woman with previous plantar fasciitis, complaining of right ankle pain for 2 months

Findings
SKELETAL/BONES:
Moderate-sized plantar calcaneal spur, at the origin of the plantar fascia with associated moderate to marked periostitis and osteoedema.

No other pattern of reactive osteoedema. No micro or macro trabecular fracture. No aggressive osseous abnormality. No stress fracture.

No os trigonum.

No hindfoot valgus deformity.

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

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

Chopart joint: Mild capsulitis of the posterior subtalar joint, with a small capsular bursal cyst. Otherwise unremarkable.

Midfoot/hindfoot: No fracture or injury of the anterior calcaneal process. No prominent midfoot or hindfoot arthrosis. Mild 2nd tarsometatarsal joint arthrosis with periarticular osteoedema.

Lisfranc articulation: Unremarkable. Intact Lisfranc ligament.

LIGAMENTS:
High ankle: Intact.

Low ankle: Slightly thickened scarred ATFL. Otherwise unremarkable low ankle ligaments.

Subtalar/Chopart: Intact.

TENDONS:
Intact.

GENERAL:
Sinus tarsi: Unremarkable.

Muscles: Moderate fatty atrophy involving abductor digiti minimi. Otherwise unremarkable intrinsic musculature of the foot.

Soft tissue: Unremarkable.

Plantar fascia: Markedly thickened proximal central cord of the plantar fascia, with a deep, near full-thickness or full-thickness incomplete tear adjacent to the calcaneal origin, measuring 1.1 cm AP diameter, 0.8 cm transverse diameter. Marked perifascial high signal inflammation noted and prominent plantar calcaneal periostitis.

Moderately thickened lateral and mildly thickened medial cords proximally.

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

Intra-articular/loose bodies: None.

Impressions
1. Marked active plantar fasciitis, most prominently involving the central cord, with a focal full-thickness or near full-thickness incomplete tear measuring 1.1 x 0.8 cm. Auto-release could account for recent symptom relief.
2. Moderate-sized plantar calcaneal spur with moderate to marked periostitis and reactive osteoedema.
3. Diffuse abductor digiti minimi fatty atrophy, consistent with coexisting Baxter’s neuropathy.