Left ankle pain There is a 2.5 cm bone fragment situated along the posterior medial aspect of the talus which may represent an ununited fracture fragment. The fragment lies just lateral to the flexor digitorum longus tendon and anterior to the flexor hallucis longus tendon. An additional ossicle measuring approximately 2 cm is seen posterior to the talus which may represent an additional ununited fracture fragment or a large os trigonum. Subcentimeter ossicles distal to the tibiofibular joint, anterior to the tibiotalar joint, and along the talonavicular joint may also be the result of prior trauma. Mild to moderate osteoarthritis affects the tibiotalar joint with anterior osteophytes and subchondral cysts present in the talar dome. There is moderate osteoarthritis of the posterior facet of the subtalar joint with osteophyte formation, near bone-on-bone apposition, and subchondral cyst formation. Moderate osteoarthritis affects the talonavicular joint with osteophyte formation and subchondral cysts present. A subchondral cyst is also noted in the lateral cuneiform which is likely degenerative in nature.The ankle tendons are normal. The anterior talofibular ligament appears to extend to the aforementioned ossicle distal to the fibula which likely represents an old avulsion injury. The calcaneofibular ligament is intact. The posterior talofibular ligament extends to the previously described os trigonum/ununited fracture fragment but is otherwise intact. The distal tibiofibular syndesmotic complex is intact. There is loss of the normal fatty striations of the deep tibiotalar fibers of the deltoid likely the result of prior injury. There is increased signal intensity on T2-weighted sequences along the anterior margin of the ankle gutters which could represent a mild synovitis. There is intermediate signal intensity within the sinus tarsus which likely represents scarring.
Multiple ossicles about the ankle further detailed above which likely represent remote fracture fragments. There is posttraumatic osteoarthritis of the ankle with other findings as described above.