## FINDINGS

**Assessment limitations:** Review is limited to the supplied sampled images, with reduced confidence for subtle cartilage abnormalities, ligament grading, and tendon split tears.

**Bones and articulations:** Narrowing and irregularity of the middle talocalcaneal articulation adjacent to the sustentaculum tali, with opposing osseous remodeling and low-signal subchondral margins, suspicious for a nonosseous coalition. No definite bridging marrow continuity.

Lobulated fluid-sensitive signal at the inferior talar neck/sulcus tali extends toward the sinus tarsi, potentially representing ganglion or subcortical cystic change; its precise intraosseous versus extraosseous extent is uncertain. Additional focal reactive/cystic marrow signal is present in the anterior-superior calcaneus adjacent to the sinus tarsi/anterior process. The calcaneonavicular interface is closely approximated and poorly defined, but a coalition at this location is not established.

Focal subchondral signal abnormality at the medial talar shoulder and adjacent medial malleolus, favored reactive/cystic or contusional. No definite overlying cartilage defect or displaced osteochondral fragment. Questionable minimal subchondral signal abnormality at the posterolateral tibial plafond may be partial volume artifact. Mild dorsal talonavicular spurring. No definite acute fracture, collapse, or malalignment.

**Joint fluid and sinus tarsi:** Small-to-moderate tibiotalar and small subtalar effusions. Partial effacement of sinus tarsi fat by fluid-sensitive and intermediate-signal tissue, potentially reflecting edema, synovial thickening, or fibrosis.

**Ligaments:** The anterior talofibular ligament is attenuated and poorly delineated, suspicious for injury; complete disruption is not established. Mild signal abnormality near the talar attachment of the deep deltoid ligament may reflect low-grade sprain or reactive change. No gross syndesmotic or posterior talofibular ligament disruption. Remaining ligament assessment is limited.

**Tendons:** Visualized Achilles, peroneal, medial flexor, and anterior extensor tendons are continuous without a definite tear. Small-volume medial flexor tendon sheath fluid, particularly around the flexor hallucis longus, may reflect joint communication or mild tenosynovitis.

**Plantar fascia:** No appreciable proximal thickening or disruption.

**Muscles and soft tissues:** Apparent patchy muscular edema involving the medial/plantar intrinsic foot musculature and partially imaged distal calf, potentially accentuated by nonuniform fat suppression. Prominent branching fluid-signal structures along the distal tarsal tunnel and plantar neurovascular course favor dilated venous channels. Mild perimalleolar, dorsal foot, and pre-Achilles soft-tissue edema. No organized collection.

## IMPRESSION

1. **Suspected nonosseous middle-facet talocalcaneal coalition**, with associated reactive remodeling. **Moderate confidence.** CT may help characterize the bony anatomy if clinically needed.
2. **Cystic-appearing abnormality at the inferior talar neck/sinus tarsi**, potentially ganglion or subcortical cystic change, with adjacent sinus tarsi inflammatory/fibrotic signal and focal anterior calcaneal reactive marrow change. **Moderate confidence.**
3. **Suspected anterior talofibular ligament injury**, not reliably graded. Possible low-grade deep deltoid sprain/reactive change. **Moderate and low confidence, respectively.**
4. **Focal medial tibiotalar subchondral reactive/cystic or contusional change**, without a definite osteochondral defect. Small-to-moderate ankle and small subtalar effusions. **Moderate confidence for subchondral changes; high confidence for ankle effusion.**
5. **Apparent nonspecific muscular edema** in the included foot and distal calf, possibly accentuated by fat-suppression artifact. Mild regional soft-tissue edema. **Moderate confidence.**