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.
