Presentation
Pain at medial aspect of ankle
Patient Data
The study reveals an accessory ossicle measuring approx. 7 x 8 mm at posteromedial aspect of navicular. Mild irregularity is seen along the pseudo-articulation with subtle marrow edema involving the posteromedial aspect of the navicular as well as the accessory ossicle.
Mild fluid is seen along the distal tibialis posterior tendon.
Mild fluid is also seen along the flexor digitorum longus and flexor hallucis tendons.
The remaining tendons around the ankle joint are unremarkable.
A fibrous calcaneonavicular coalition is seen with no obvious marrow edema in the present scan.
Low-grade sprain of anterior, posterior talofibular and anterior inferior tibiofibular ligaments is seen. Their continuity is maintained.
The deltoid ligament complex is unremarkable.
No obvious marrow edema is seen in the rest of visualized bones.
Mild Achilles tendinosis is seen.
Plantar fascia is unremarkable.
Mild joint effusion is seen. Mild fluid is also seen in the posterior recess. No obvious os trigonum or prominent Stieda process is however seen.
Case Discussion
Accessory ossicle (os tibiale externum type 2) with a pseudo-articulation to the posteromedial surface of navicular bone that shows mild bone marrow edema is likely the cause of pain in this patient (pain marker placed adjacent to it) and indicates os naviculare syndrome.
The fluid along the distal tibialis posterior tendon is reactive and likely represents mild tenosynovitis.
As an incidental finding, there is a fibrous calcaneonavicular coalition with no obvious bone marrow edema present.
Unable to process the form. Check for errors and try again.