## FINDINGS

### Bones / Articular Cartilage / Joints
- **Medial talar dome/medial talar shoulder:** Chronic-appearing osteochondral/subchondral abnormality with focal subchondral cystic/low T1 signal change and surrounding STIR hyperintense marrow edema, centered at the medial-to-central talar dome/body-neck region. Mild adjacent articular surface irregularity/flattening is present. No displaced osteochondral fragment, subchondral collapse, acute fracture, or osteonecrosis identified.
- **Tibiotalar joint:** Mild chronic post-traumatic/degenerative arthrosis with marginal spurring, including anterior distal tibial plafond and dorsal talar neck osteophytes, compatible with anterior ankle impingement morphology. Small to moderate tibiotalar joint effusion with mild synovitis/pericapsular fluid signal, greatest in the anterior recess and lateral gutter.
- **Lateral gutter/fibular tip:** Small corticated ossific focus/irregular ossific prominence near the distal fibular tip/lateral gutter, favored chronic post-traumatic avulsion change/os subfibulare. Mild lateral gutter soft-tissue scarring/synovitis.
- **Talonavicular/dorsal midfoot:** Mild dorsal talar head/neck beaking and dorsal midfoot osteophytic change.
- **Subtalar joint/sinus tarsi:** Mild subtalar recess fluid/synovitis. Partial effacement/irregularity of normal sinus tarsi fat with fluid-sensitive hyperintensity and fibrous low-signal tissue, compatible with sinus tarsi inflammation/scarring. Mild irregularity/narrowing of the middle subtalar facet is suggested; talocalcaneal coalition is not definitively demonstrated.

### Ligaments
- **Lateral ligament complex:** The ATFL is not visualized as a normal continuous low-signal band and there is scarring/soft-tissue thickening in its expected course, compatible with chronic high-grade ATFL sprain/tear. The calcaneofibular/lateral collateral ligament region is mildly indistinct/thickened, compatible with chronic sprain/scarring; no acute complete CFL disruption is evident.
- **Syndesmotic ligaments:** Grossly preserved.
- **Deltoid ligament complex:** No definite tear identified.

### Tendons
- **Flexor hallucis longus:** Prominent fluid in the FHL tendon sheath extending from the posterior ankle toward the plantar-medial hindfoot, compatible with tenosynovitis. Tendon remains continuous.
- **Peroneal tendons:** Mild peroneal tendon sheath fluid compatible with mild tenosynovitis. No definite split tear or tendon discontinuity.
- **Posterior tibial, flexor digitorum longus, anterior extensor tendons:** Grossly intact without definite tear.
- **Achilles tendon:** Intact without tear or significant tendinosis.
- **Plantar fascia:** Mild plantar calcaneal enthesophyte. No plantar fascial tear.

### Soft Tissues
- Mild nonspecific periarticular/subcutaneous edema, greatest laterally about the ankle/sinus tarsi region. No soft-tissue mass or drainable fluid collection.

## IMPRESSION

1. **Chronic osteochondral lesion/subchondral cystic change of the medial talar dome/medial talar shoulder** with surrounding marrow edema and mild articular surface irregularity. No displaced fragment or collapse. **Confidence: high for talar osteochondral/subchondral abnormality; medium-high for precise articular extent.**

2. **Chronic lateral ankle ligament injury, greatest involving the ATFL**, with nonvisualization/attenuation of the normal ATFL and anterolateral gutter scarring; mild chronic CFL/lateral collateral ligament scarring. Associated small chronic avulsion fragment/os subfibulare at the fibular tip. **Confidence: medium-high.**

3. **Mild post-traumatic/degenerative tibiotalar arthrosis with anterior ankle impingement morphology**, including anterior tibial plafond/dorsal talar neck spurring, and small-to-moderate tibiotalar effusion/synovitis. **Confidence: high.**

4. **Sinus tarsi inflammation/scarring with mild subtalar recess fluid/synovitis**, likely chronic/post-traumatic. Mild middle subtalar facet irregularity is suggested; talocalcaneal coalition is not definitively confirmed. **Confidence: medium.**

5. **FHL tenosynovitis** and **mild peroneal tenosynovitis** without definite tendon tear. **Confidence: high for FHL; medium for peroneal tenosynovitis.**