68-year-old female with joint pain. Evaluate for fracture.IMAGE ACQUISITIONS: CT through the right ankle performed without contrast enhancement and reformatted images obtained for sagittal, coronal and axial reconstructions. In addition, 3-D reconstruction was done at an independent work station. Non-infused CT of the right ankle shows no evidence of acute fracture. Severe osteoarthritis affects the talonavicular joint, with bone-on-bone apposition and prominent subchondral cysts. Subchondral cysts are also seen at the subtalar and calcaneocuboid joints. Mild osteoarthritis at the tibiotalar joint. There is a large os trigonum posterior to the talus. The navicular appears to be slightly inferiorly subluxed with respect to the talus. There is eversion of the calcaneus with resultant osteoarthritic changes of the calcaneofibular articulation. There are small loose bodies in the lateral gutter of the ankle. Recent radiographs suggest a severe planovalgus deformity.Soft tissue attenuation along the head of the talus and the distal fibula may represent edema or scar tissue, and obscures the ligamentous structures of the ankle. The Achilles tendon is intact and the remaining ankle tendons are grossly intact, given the inherent limitations of CT or examination; however, we cannot exclude a partial-thickness tendon tear on CT, and if further imaging is warranted clinically, MRI can be considered.
1. No evidence of acute fracture.2. Arthritic changes as described above, including eversion of the calcaneus and plantar subluxation of the navicular, which may reflect a neuropathic arthropathy or chronic posterior tibialis tendon dysfunction.