Reason: eval posterior heel soft tissues, achilles, subtalar joint, and adjacent soft tissue for swelling History: pain TENDONS: The Achilles tendon is normal in appearance. On fluid sensitive sequences, there is a thin band of increased signal intensity within the soft tissues immediately posterior to the distal Achilles tendon which may reflect mild inflammation of an adventitious retro-Achilles bursa. There is a small amount of fluid within the tendon sheath of the flexor hallucis longus immediately proximal to the talus and proximal to the knot of Henry. The posterior tibialis and flexor digitorum longus tendons appear normal. The anterior tendons appear intact. Small quantities of fluid are noted within the tendon sheaths of the peroneal tendons as they course along the anterior margin of the calcaneus, but this is of doubtful clinical significance.LIGAMENTS: The lateral collateral ligament complex appears intact. There is loss of the normal fatty striations of the deep tibiotalar component of the deltoid ligament which may reflect prior injury or degeneration, but this is not necessarily of any current clinical significance. The distal tibiofibular syndesmotic complex appears intact.ARTICULAR SURFACES AND BONE: There is a small to moderate-sized tibiotalar joint effusion as well as fluid within the posterior recess of the subtalar joint. There is an os trigonum, but there is no edema noted within the ossicle. There is minimal edema type signal within the medial portion of the body of the talus near the insertion of the deltoid ligament which is nonspecific, but may simply be degenerative in etiology. There is also mild edema type signal within the lateral portion of the posterior tuberosity and body of the calcaneus which is nonspecific. This could either represent marrow edema due to enthesopathy at the insertion of the Achilles tendon (although the tendon itself appears normal) or perhaps a stress reaction. There is mild edema within the overlying subcutaneous fat. There is a small defect along the anteromedial aspect of the tibial plafond likely representing a normal variant notch of Harty. We see no fluid-filled osteochondral defect. ADDITIONAL
1. Mild edema-type signal within the posterolateral calcaneus is nonspecific and could represent a stress reaction or perhaps inflammatory enthesopathic changes at the insertion of the Achilles tendon, although the tendon itself appears normal. There is also mild edema within the overlying subcutaneous fat as well as minimal inflammation posterior to the Achilles tendon which may represent a mild adventitious bursitis.2. Mild to moderate tibiotalar joint effusion as well as fluid within the posterior recess of the subtalar joint. Small amounts of fluid along the flexor hallucis longus tendon, as noted above, are not necessarily of any clinical significance.3. Os trigonum without edema within the ossicle or adjacent bone.4. Nonspecific subcutaneous edema along the medial and lateral aspects of the ankle.