Patient History
69 F with foot pain and medial ankle swelling
Findings
ARTICULATIONS:
Bone: Patchy heterogeneous, feathery osteoedema scattered throughout the midfoot mainly involving the talar head and neck, the navicular, cuneiform and lateral cuboid extending to the middle subtalar, talonavicular, calcaneocuboid, naviculocuneiform and the entire tarsometatarsal joints.
No displaced fractures, cortical breakthrough or periosteal reactions.
Tibiotalar Joint: No osteochondral defect. No arthropathy.
Hindfoot: No arthropathy.
Midfoot: No arthropathy.
Forefoot: No arthropathy. No evidence of hallux valgus deformity.
Lisfranc Joint: The Lisfranc joint is intact, without fracture or joint space widening.
LIGAMENTS:
Anteroinferior Tibiofibular Ligament: Intact.
Posteroinferior Tibiofibular Ligament: Intact.
Interosseous Membrane and Ligament: Intact.
Anterior Talofibular Ligament: Intact.
Posterior Talofibular Ligament: Intact.
Calcaneofibular Ligament: Intact.
Deltoid Ligament Complex: Intact.
TENDONS:
Peroneus Longus/Brevis: Intact.
Posterior Tibialis: Intact.
Flexor Compartment: Intact.
Extensor Compartment: Intact.
Plantar Plates: Intact.
GENERAL:
Muscles: No traumatic muscle injury. No volumetric muscle atrophy.
Soft Tissue: Diffuse reactive periarticular soft tissue swelling throughout the distal lower leg, ankle, hind and midfoot. Soft tissue edema within the Kager's fat pad.
Plantar Fascia: Intact.
Joint Effusion: Small tibiotalar and posterior subtalar joint effusions.
Intra-Articular/Loose Bodies: None.
Impressions
1. Patchy heterogeneous, feathery osteoedema scattered throughout the midfoot mainly involving the talar head and neck, navicular, cuneiform and lateral cuboid extending to the middle subtalar, talonavicular, calcaneocuboid, naviculocuneiform and entire tarsometatarsal joints. Findings in keeping with complex regional pain syndrome/Sudeck's atrophy/reflex sympathetic dystrophy. No underlying nerve lesion noted.
2. No displaced fractures, cortical breakthrough or periosteal reactions.
3. Diffuse reactive periarticular soft tissue swelling throughout the distal lower leg, ankle, hind and midfoot.
4. Small tibiotalar and posterior subtalar joint effusions.
5. OS Trigonum
