## FINDINGS

### Bones, alignment, and marrow
No acute fracture, dislocation, aggressive marrow lesion, or diffuse marrow abnormality. Hindfoot alignment is grossly preserved.

There are chronic anterior tibiotalar marginal osteophytes involving the anterior distal tibial plafond and dorsal/anterior talar neck, with “kissing” anterior ankle spurs. Small low-signal/corticated foci in the anterior ankle recess may reflect chronic osteophyte fragments or small intra-articular bodies.

Small plantar calcaneal enthesophyte.

### Tibiotalar joint, cartilage, and talar dome
Small to moderate tibiotalar joint effusion with mild synovial/capsular fullness, compatible with synovitis.

Focal chronic osteochondral/chondral-subchondral abnormality of the medial to posteromedial talar dome/shoulder, with small subchondral low T1/cystic signal and mild overlying articular surface irregularity/flattening. No displaced osteochondral fragment is identified. No conspicuous surrounding acute marrow edema.

Mild tibiotalar degenerative change, greatest anteriorly and in the medial gutter, with mild cartilage thinning/irregularity and marginal spurring.

### Subtalar joint and sinus tarsi
Trace to small posterior subtalar joint fluid. Mild subtalar articular irregularity/degenerative change is suspected.

Partial effacement of the normal sinus tarsi fat with low-intermediate T1 signal and fluid/edema-like signal, compatible with chronic sinus tarsi scarring/fibrosis and synovitis-type change. Middle subtalar facet region appears narrowed/irregular; fibrocartilaginous talocalcaneal coalition versus chronic subtalar degenerative change is possible but not definitive on this exam.

### Ligaments
Anterior talofibular ligament is attenuated, irregular, and poorly defined, compatible with chronic ATFL sprain/tear/scarring. Associated anterolateral gutter capsular/synovial irregularity and scarring are present, which may contribute to anterolateral impingement symptoms.

Calcaneofibular ligament is mildly indistinct where visualized, possibly reflecting chronic sprain/scarring, without definite acute discontinuity.

Posterior talofibular ligament, syndesmotic ligaments, and deltoid ligament complex are grossly intact on the provided sequences without definite acute tear.

### Tendons
Mild peroneal tendon sheath fluid, compatible with mild peroneal tenosynovitis. Peroneus brevis and longus tendons are intact without definite split tear or dislocation.

Fluid tracks along the flexor hallucis longus tendon sheath/posterior ankle recess, favored related to the ankle effusion; mild FHL tenosynovitis is possible. FHL tendon is intact.

Posterior tibial, flexor digitorum longus, anterior extensor tendons, and Achilles tendon are intact. Plantar fascia is intact with mild chronic enthesopathic change at the calcaneal origin.

### Soft tissues
Mild nonspecific periarticular/subcutaneous edema, greatest laterally. No soft-tissue mass or focal drainable fluid collection.

## IMPRESSION

1. **Chronic osteochondral lesion of the medial/posteromedial talar dome/shoulder**, with small subchondral cystic/low T1 change and mild articular surface irregularity. **No displaced osteochondral fragment identified.**  
   **Confidence: Medium.**

2. **Chronic lateral ankle ligament injury, greatest involving the ATFL**, which is attenuated/irregular and poorly defined, with associated anterolateral gutter scarring/synovitis. Findings may contribute to chronic anterolateral ankle impingement symptoms.  
   **Confidence: Medium-high.**

3. **Small to moderate tibiotalar effusion with mild synovitis.**  
   **Confidence: High.**

4. **Chronic anterior tibiotalar degenerative/impingement-type change** with anterior distal tibial and talar neck osteophytes; possible small chronic anterior osteophyte fragments/intra-articular bodies.  
   **Confidence: High for osteophytes; Low-medium for small bodies/fragments.**

5. **Sinus tarsi scarring/fibrosis with mild subtalar degenerative/synovitis-type change.** Narrowing/irregularity of the middle subtalar facet raises the possibility of fibrocartilaginous talocalcaneal coalition versus chronic subtalar degeneration, not definitive.  
   **Confidence: Medium.**

6. **Mild peroneal tenosynovitis** and possible mild FHL tenosynovitis/communication with ankle joint fluid. Tendons remain intact.  
   **Confidence: Medium.**