Patient History
62 F pain and swelling over peroneal tendons for a year
Findings
ARTICULATIONS:
Bone: No acute fracture. Chronic avulsion injury of the fibular styloid at the lateral malleolus. Prominent confluent friction osteoedema of the lateral calcaneal body.
Dystrophic enlargement of the peroneal tubercle in the lateral calcaneal body.
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.
Hindfoot: No fracture or injury of the anterior calcaneal process.
Midfoot/Lisfranc Joint: Penetrating chondromalacia at the lateral cuneiform (C3) and cuboid articulation as well as the lateral naviculocuneiform joint. Mild osteoarthrosis and spurring at the dorsal aspect of the talonavicular joint. The Lisfranc joint is intact, without fracture or joint space widening.
LIGAMENTS:
Anterior/Posterior Talofibular: Chronic injury with diffuse attenuation of the anterior talofibular ligament (ATFL). The posterior talofibular ligament (PTFL) is intact.
Calcaneofibular: Diffusely scarred calcaneofibular ligament (CFL).
Deltoid: Intact.
High Ankle: Intact.
Subtalar/Chopart: Intact.
Collateral Ligaments: Intact.
TENDONS:
Achilles: Intact.
Peroneus Longus/Brevis: A 3.5 cm-4 cm hypertrophic longitudinal split tear involving the supra, juxta and inframalleolar segments of the peroneus longus and brevis associated with severe tenosynovitis. The superior and inferior peroneal retinaculum are intact.
Posterior Tibialis: Intact.
Flexor Compartment: Intact.
Extensor Compartment: Mild tenosynovitis of the extensor digitorum most conspicuous at the dorsal hindfoot overlying the talar neck.
GENERAL:
Muscles: No traumatic muscle injury. No volumetric muscle atrophy.
Soft Tissue: Prominent skin thickening and soft tissue swelling overlying the lateral malleolus.
Plantar Fascia: Intact.
Neurovascular Complex/Tarsal Tunnel: No space-occupying lesion. No evidence of entrapment neuropathy.
Joint Effusion: Small tibiotalar joint effusion.
Intra-articular/Loose Bodies: None.
Impressions
1. Background dystrophic enlargement of the calcaneus peroneal tubercle resulting in a 3.5 cm-4 cm chronic hypertrophic longitudinal split tear involving the supra, juxta and inframalleolar segments of the peroneus longus and brevis with prominent reactive tenosynovitis and soft tissue swelling overlying the lateral malleolus.
2. Prominent confluent friction osteoedema of the lateral calcaneal body.
3. Chronic ankle inversion injury with avulsion fracture of the fibular styloid at the lateral malleolus, site of insertion of the ATFL. Diffuse attenuation of the ATFL and diffusely scarred CFL.
4. Osseous fragments in the anterolateral fibular gutter.
5. Mild tenosynovitis of the extensor digitorum.
