Lab Studies:
Negative ANA, RF, CRP, ESR, TSH and Vit D.
Other Studies:
1. Right ankle ultrasound: Thickened right distal Achilles tendon at 0.60cm, compared to 0.52cm on left.
2. Right ankle 3 view x-ray: Normal. Case Photo #1
3. Right ankle MRI: Mild edema adjacent to flexor hallucis longus tendon, caudal to sustentacular tali, this may represent peritendonitis. Case Photo #2 Case Photo #3
4. Right ankle CT scan: Unremarkable. Case Photo #4 Case Photo #5
Consultations:
Podiatry, who ruled out atypical fracture with CT scan. In collaborative review of MRI, discovered stieda process causing posterior ankle impingement with associated flexor hallucis longus tendinosis.
Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.