FOOT AND ANKLE
2025
,1*Figures 1 and 2 are the T2-weighted MR image and AP radiograph of a 55-year-old laborer who
sustains an ankle sprain after a fall from scaffolding. Initial films are read by radiology as normal. Despite
an exhaustive 6-month course of immobilization; shoe modifications; and therapy, the patient continues
to have activity-related lateral hindfoot pain, which has prevented him from returning to work. On
examination, the patient has full eversion strength that is painless. Ankle range of motion is full and
painless. No anterior drawer is observed. There is tenderness and mild swelling distal to the sinus tarsi.
Sensation and motor are intact and the skin is otherwise unremarkable in appearance. An MRI is
obtained. What is the next best step?
,1- Referral for complex regional pain syndrome (CRPS) workup
2- Lace-up ankle brace
3- Excision of the superior anterior process of the calcaneus
4-Arthroscopic Brostrom
Correct answer : 3
The patient has a nonunion of anterior process of the calcaneus. His symptoms are consistent with the
examination and imaging findings, and he has failed nonsurgical treatment. Therefore, surgical excision
of the nonunion fragment is indicated. No findings consistent with CRPS are seen in this patient. He has
activity-related pain at a focal area and is without skin changes. A lace-up ankle brace is unlikely to
provide substantial immobilization and pain control at the hindfoot. In addition, the patient has tried
nonsurgical therapies without lasting improvement. The patient has complaints, examination, and
imaging findings consistent with a single diagnosis. A lateral ankle stabilization procedure such as a
Brostrom is not indicated because the patient has no instability on examination.
, 2*Figure s1 sis sthe sT1-weighted slateral sMR simage sand sFigure s2 sis sthe sT2-weighted slateral sMR
simage sof sa s25-year-old swoman swith sankle spain sfor sthe slast syear sthat sis sassociated swith
swalking sdown sstairs sand splaying ssports. sNo sknown sinjury shas sbeen sidentified. sThe sankle spain
shas sbeen smanaged swith srest, stherapy sfor srange sof smotion, sand sa speriod sof simmobilization.
sIntra-articular ssteroid sinjection sprovided slimited srelief sof ssymptoms. sWhat sis sthe sbest snext
sstep?
2025
,1*Figures 1 and 2 are the T2-weighted MR image and AP radiograph of a 55-year-old laborer who
sustains an ankle sprain after a fall from scaffolding. Initial films are read by radiology as normal. Despite
an exhaustive 6-month course of immobilization; shoe modifications; and therapy, the patient continues
to have activity-related lateral hindfoot pain, which has prevented him from returning to work. On
examination, the patient has full eversion strength that is painless. Ankle range of motion is full and
painless. No anterior drawer is observed. There is tenderness and mild swelling distal to the sinus tarsi.
Sensation and motor are intact and the skin is otherwise unremarkable in appearance. An MRI is
obtained. What is the next best step?
,1- Referral for complex regional pain syndrome (CRPS) workup
2- Lace-up ankle brace
3- Excision of the superior anterior process of the calcaneus
4-Arthroscopic Brostrom
Correct answer : 3
The patient has a nonunion of anterior process of the calcaneus. His symptoms are consistent with the
examination and imaging findings, and he has failed nonsurgical treatment. Therefore, surgical excision
of the nonunion fragment is indicated. No findings consistent with CRPS are seen in this patient. He has
activity-related pain at a focal area and is without skin changes. A lace-up ankle brace is unlikely to
provide substantial immobilization and pain control at the hindfoot. In addition, the patient has tried
nonsurgical therapies without lasting improvement. The patient has complaints, examination, and
imaging findings consistent with a single diagnosis. A lateral ankle stabilization procedure such as a
Brostrom is not indicated because the patient has no instability on examination.
, 2*Figure s1 sis sthe sT1-weighted slateral sMR simage sand sFigure s2 sis sthe sT2-weighted slateral sMR
simage sof sa s25-year-old swoman swith sankle spain sfor sthe slast syear sthat sis sassociated swith
swalking sdown sstairs sand splaying ssports. sNo sknown sinjury shas sbeen sidentified. sThe sankle spain
shas sbeen smanaged swith srest, stherapy sfor srange sof smotion, sand sa speriod sof simmobilization.
sIntra-articular ssteroid sinjection sprovided slimited srelief sof ssymptoms. sWhat sis sthe sbest snext
sstep?
