Reason: R distal tibia abnormality with persistent pain, evaluate for AVN, neoplasm vs insufficiency fx History: above. TENDONS: The tendons are intact with no evidence of tendinosis or tenosynovitis. Previously seen fluid within the flexor analysis longus tendon sheath just proximal to the ninth Henry has resolved. Previously seen increased signal within the peroneus brevis tendon is no longer visualized.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular syndesmotic complex is intact. The deep fibers of the deltoid ligament have lost their normal striations and there is an ossicle distal to the medial malleolus. These findings suggest old trauma. The superficial components of the deltoid ligament appear unusually thickened which may likewise reflect old injury.ARTICULAR SURFACES AND BONE: Edema within the distal tibia has decreased compared to prior with residual subchondral edema likely degenerative in etiology. Additional foci of signal abnormality within the foot are similar to prior and likely reflect mild osteoarthritis. New diffuse edema within the medial cuneiform. New edema within the sinus tarsi and the overlying talus. Metallic artifact within the head and neck of the first metatarsophalangeal joint represents arthroplasty which is incompletely imaged on this study. ADDITIONAL
1.New edema within the medial cuneiform bone, sinus tarsi and overlying talus, suggestive of transient osteoporosis, which can manifest as transient bone marrow edema.2.Resolution of previously seen stress fracture involving the distal tibia. 3.Resolution of previously seen ankle tendinosis. 