Midfoot arthritis with incidental bilateral os peroneus and os naviculare
Presentation
Pain and swelling at the dorsal aspect of foot
Patient Data
Reduced 2nd and 3rd tarsometatarsal joint spaces with marginal osteophytes, subchondral cystic changes/ erosions and subchondral marrow edema (more pronounced at 2nd tarsometatarsal joint). Significant subcutaneous edema is seen at dorsal aspects.
Similar changes are also seen at articular aspects of navicular and middle cuneiform joint with subchondral cysts / erosions and significant marrow edema in navicular bone.
Loss of articular cartilage seen along tibiotalar joint with subchondral cyst in distal tibia. No significant marrow edema seen.
Prominent bony spur is seen along planter aspects of calcaneum, medially with no obvious evidence of plantar fasciitis in present scan.
Small well corticated accessory bones are seen at posterolateral aspect of cuboid and posteromedial aspect of navicular bones respectively representing os peroneus and os navicular respectively. No evidence of marrow edema is seen involving these in present scan.
No significant tenosynovitis seen.
Lateral and medial ligaments of ankle joint appear intact.
No significant joint effusion seen.
Note is made of Achilles tendinosis involving a length of approx. 36 mm, approx. 10 mm proximal to the attachment site.
CT screening was done including the right foot, to rule out any inflammatory arthritis such as rheumatoid which is likely to be bilateral. Small well corticated accessory bones are seen at posterolateral aspect of cuboid and posteromedial aspect of navicular bones representing os peroneus and os navicular respectively.
Osteoarthritic changes are also seen in right foot; however much less pronounced as compared to the left.
Case Discussion
Above findings are suggestive of osteoarthritic changes, predominantly involving the mid foot. In the absence of any significant synovial proliferation, tenosynovitis, typical location of findings with subchondral erosions/cystic changes being subarticular rather than periarticular, possibility of inflammatory/infective arthritis is less likely.
Small well corticated accessory bones are seen at posterolateral aspect of cuboid and posteromedial aspect of navicular bones representing os peroneus and os navicular respectively.
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