21-year-old male with foot pain. Chronic plantar medial arch pain. Evaluation of the medial aspect of the midfoot and first metatarsal is limited by metallic susceptibility artifact related to orthopedic screws across the first tarsometatarsal joint from prior Lapidus procedure. Based on prior radiographs, the patient has also undergone resection of an accessory navicular bone. Multiple low signal intensity foci within the medial soft tissues extending from the tip of the medial malleolus to the medial cuneiform represent metallic susceptibility artifact related to prior surgery. This same tissue enhances following contrast administration, perhaps representing scarring/granulation tissue. There is a surgical tunnel within the navicular tuberosity. On the axial images, the posterior tibialis and flexor hallucis longus tendons can be followed to just beneath the medial malleolus, distal to which they become indistinct amidst the aforementioned scarring/scar tissue. The tendons are slightly better visualized on the STIR sagittal sequence. The fibers of the posterior tibialis appear to extend to the navicular and presumably enter the aforementioned tunnel. The flexor digitorum longus also appears to extend to the navicular and presumably enters the tunnel, although the tendon just proximal to the navicular contains increased signal intensity which could represent degeneration, inflammation, or tearing. The visualized portions of the flexor hallucis longus tendon appear normal. The Achilles tendon appears intact. The lateral tendons appear intact. The anterior tendons appear intact. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact. The signal intensity of the remaining bones is within normal limits. There is no joint effusion. The musculature of the foot is unremarkable.
1. Limited evaluation of the medial aspect of the midfoot and forefoot related to orthopedic screws from prior Lapidus procedure.2. Postoperative changes of accessory navicular resection and tendon transfer as described above. Enhancement of the medial soft tissues of the hindfoot and midfoot presumably represents scar tissue. Evaluation of the transposed posterior tibialis and flexor digitorum longus tendons is limited due to this scar tissue. Please see above for further details.